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PRINTED: 08/30/2022 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION
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How to fill out and state licensure review

01
Contact the appropriate state licensing board for the specific profession you are applying for licensure in.
02
Obtain the necessary application forms from the licensing board website or office.
03
Fill out the application completely and accurately, providing all required information and documentation.
04
Submit the application along with any required fees to the licensing board.
05
Wait for the licensing board to review your application and grant or deny licensure based on their review.

Who needs and state licensure review?

01
Individuals who are seeking to practice a licensed profession in a specific state.
02
Professionals who need to demonstrate their qualifications and meet state requirements for licensure.
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The and state licensure review is a process where individuals or entities are required to report their professional licenses and certifications to a state licensing board for review.
Individuals or entities holding professional licenses or certifications are required to file an state licensure review.
To fill out an state licensure review, individuals or entities must provide information about their professional licenses and certifications, including license numbers and expiration dates.
The purpose of an state licensure review is to verify that individuals or entities holding professional licenses or certifications are in compliance with state licensing requirements.
Information such as license numbers, expiration dates, and any disciplinary actions must be reported on an state licensure review.
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