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PRINTED: 06/16/2023 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 complaint in00410083- no deficiencies refers to a formal grievance or report that indicates there are no identified deficiencies in a particular matter or process.
Individuals or entities that are directly impacted by the subject of the complaint are typically required to file the complaint in00410083- no deficiencies.
To fill out the complaint in00410083- no deficiencies, the filer must complete the designated complaint form, providing relevant details and affirmations that no deficiencies exist, and submit it to the appropriate authority.
The purpose of the complaint in00410083- no deficiencies is to document and formally acknowledge that there are no deficiencies present, which can be important for compliance and record-keeping.
The complaint must report the identity of the filer, details about the subject matter, affirmations of no deficiencies, and any relevant evidence or supporting documentation.
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