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PRINTED: 08/15/2017 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION
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The 0815 form, approved by the Office of Management and Budget (OMB), is a document used for specific reporting requirements set forth by various federal agencies.
Entities or individuals who meet the specific criteria outlined by the federal agency responsible for the form are required to file the 0815 form.
To fill out the 0815 form, one should carefully follow the instructions provided on the form, ensuring to include all required information and to sign where indicated.
The purpose of the 0815 form is to collect necessary data for federal reporting, ensuring compliance with specific regulations and policies.
Information such as entity details, financial data, and compliance information must be reported on the 0815 form, as specified in the instructions.
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