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PRINTED: 03/21/2018 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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Start by clearly identifying the complaint number in question - in this case, 00256382.
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State the reason for the complaint - in this case, unsubstantiated due.
03
Provide detailed information and evidence to support your claim of the complaint being unsubstantiated.
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The complaint in00256382- unsubstantiated is a notification or formal grievance that has not been proven or verified.
Typically, the individual or organization affected by the issue or incident is required to file the complaint.
To fill out the complaint, gather all relevant details, complete the designated form accurately, and submit it to the appropriate authority.
The purpose of the complaint is to formally report an issue, seek resolution, and document the matter for future reference.
The complaint must typically include the complainant's details, the nature of the complaint, relevant dates, and any supporting evidence.
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