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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION NUMBER:15535204/08/2014FORM

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Fill out the personal information section with your name, address, and contact information.

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Complaint in00143947 is a formal grievance or charge related to a specific issue, designated by the identifier in00143947, which needs to be addressed by the appropriate authority.

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Any individual or entity who has been affected by the issue described in complaint in00143947 is required to file the complaint.

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To fill out complaint in00143947, one must complete all relevant sections of the complaint form, providing accurate details about the issue and attaching any necessary documentation.

What is the purpose of complaint in00143947?

The purpose of complaint in00143947 is to formally report an issue, initiate an investigation, and seek resolution or corrective action regarding the matter.

What information must be reported on complaint in00143947?

The complaint must include the complainant's contact information, a clear description of the issue, relevant dates, and any evidence supporting the claim.

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