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PRINTED: 08/28/2024 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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How to fill out a paper follow-up was

How to fill out a paper follow-up was
01
Gather all necessary documents related to the initial appointment or service.
02
Fill in personal information such as name, address, and contact details at the top of the paper.
03
Include the date of the original appointment and any relevant reference numbers.
04
Clearly state the reason for the follow-up, mentioning any specific concerns or questions.
05
If applicable, check or fill in additional sections regarding symptoms, changes in condition, or new information.
06
Review the filled-out form for completeness and accuracy.
07
Submit the form to the appropriate office or personnel, either in person or through designated channels.
Who needs a paper follow-up was?
01
Patients who have had previous medical appointments and require further evaluation.
02
Individuals seeking updates on their health status or treatment progress.
03
Those who need to provide additional information to healthcare providers after an initial consultation.
04
Persons involved in ongoing medical research or studies requiring follow-up data.
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