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PRINTED: 02/14/2022 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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How to fill out 849 big oak road

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Start by writing your full name in the first line.

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In the second line, write your street number, which is 849.

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In the third line, write the street name, which is Big Oak Road.

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