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PRINTED: 03/08/2022 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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What is form investigation of complaint?

Form investigation of complaint is a document used to report a complaint and request an investigation into a specific issue.

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Form investigation of complaint requires information such as the nature of the complaint, details of the incident, names of parties involved, and any supporting evidence.

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