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PRINTED: 07/17/2015 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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Submission of this plan is the process of submitting a detailed proposal or document outlining a specific plan or strategy.

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The purpose of submission of this plan is to communicate a strategic plan or proposal to relevant parties for review and approval.

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