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PRINTED: 04/27/2007 FORM APPROVEDDivision of Health Improvement STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1)PROVIDERISUPPLIER/CLIA IDENTIFICATION NUMBER:(X2) MULTIPLE01 LAUREL HEIGHTSSTREETOR
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l - health care refers to the tax form used by certain employers to report information regarding health care coverage offered to employees.
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Information required includes employer details, employee information, months of coverage, and details about the health plans provided including minimum essential coverage.
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