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Printed: 09/02/2024
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
IDENTIFICATION
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1075 heaformr green drive is a specific form used for reporting certain information related to environmental compliance or sustainability measures undertaken by businesses.
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