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PRINTED: 01/17/2020 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:RIVER CROSSING ASSISTED LIVING
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Form investigation of complaint is a formal form used to report a complaint or issue to the proper authorities for investigation.
Any individual or organization that has a complaint or issue that requires investigation is required to file the form.
The form can be filled out by providing details of the complaint or issue, including relevant dates, names, and any supporting documentation.
The purpose of the form is to initiate an investigation into a complaint or issue in order to address and resolve the situation.
The form typically requires details of the complaint, names of individuals involved, dates, and any supporting evidence.
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2019 2020 indiana psr in00311440 in00309170 in00300933 lsc licensure charlestown x2 x3 x4 iac clia sgqp12 x6 x1 x5 referenced deficiencies regulatory prefix continuation corrective preceded revisit compliance deficiency conjunction census provider summary

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