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Printed: 06/21/2024 Form Approved OMB No. 09380391Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA

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How to fill out 1200 w 15th st

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Start by writing the house number '1200' in the first slot.

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Write 'w' for west in the second slot.

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