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PRINTED: 06/20/2019 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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Read and understand the instructions provided for the complaint survey.

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Customers who have had a negative experience with a product or service.

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What is a complaint survey was?

A complaint survey is a formal document used to report issues, concerns, or grievances regarding a particular situation, product, or service.

Who is required to file a complaint survey was?

Any individual who has encountered a problem or is dissatisfied with a product or service may be required to file a complaint survey.

How to fill out a complaint survey was?

To fill out a complaint survey, one must provide detailed information about the issue, the parties involved, and any supporting evidence.

What is the purpose of a complaint survey was?

The purpose of a complaint survey is to bring attention to problems or issues in order to seek resolution or improvement.

What information must be reported on a complaint survey was?

Information such as the nature of the complaint, the date and time of occurrence, individuals involved, and any relevant documents or evidence must be reported.

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