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PRINTED: 06/26/2023 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION A.
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How to fill out koody health care services
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People living in remote or rural areas where access to traditional healthcare services is limited.
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Information such as the type of medical service received, the date of service, the healthcare provider, and any insurance information must be reported on koody health care services.
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