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PRINTED: 08/08/2024 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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Gather all necessary information such as patient's name, date of visit, and reason for follow-up.

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Patients who require further monitoring or care after an initial visit.

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