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PRINTED: 07/27/2023 DEPARTMENT OF HEALTH AND HUMAN SERVICESFORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 09380391STATEMENT OF DEFICIENCIES AND(X1) PROVIDER/SUPPLIER/CHAPMAN OF CORRECTIONSIDENTIFICATION

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What is this visit was for?

This visit was for a routine inspection.

Who is required to file this visit was for?

The head of the department is required to file this visit.

How to fill out this visit was for?

You can fill out this visit by completing the online form provided by the organization.

What is the purpose of this visit was for?

The purpose of this visit is to ensure compliance with regulations and standards.

What information must be reported on this visit was for?

The information that must be reported includes the date of the visit, findings, and any corrective actions taken.

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