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PRINTED: 04/11/2024 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION
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The complaint in00430925 refers to a specific grievance filed regarding a violation or issue, typically within a legal or regulatory framework.
Generally, the individual or entity affected by the issue outlined in the complaint is required to file it.
To fill out the complaint, one typically needs to provide details of the incident, including dates, involved parties, and a clear explanation of the issue.
The purpose of the complaint is to formally bring attention to a discrepancy or violation, seeking resolution or corrective action.
Information typically required includes the complainant's contact details, a description of the grievance, relevant dates, and any supporting documentation.
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