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04/28/2023PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICESFORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/CLIAAND PLAN OF CORRECTIONIDENTIFICATION
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The complaint in00405456 is a formal legal document filed to initiate a grievance or dispute resolution process within the state.
Typically, the individual or entity that has experienced a grievance or is seeking redress must file the complaint.
To fill out the complaint, one must provide their personal information, detailed account of the grievance, relevant evidence, and any supporting documents.
The purpose of the complaint is to formally present an issue to the appropriate authority for investigation and resolution.
The complaint must include personal identification details, a clear description of the issue, the parties involved, and any supporting evidence.
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