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PRINTED: 03/28/2022 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 printed 0328 - form?

Printed 0328 - form is a tax form used to report certain information.

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The specific information that must be reported on printed 0328 - form will be outlined in the instructions provided with the form.

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