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PRINTED: 11/12/2024 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION
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Complaint IN00440352 refers to a specific grievance or allegation made concerning a lack of deficiencies in a particular matter, indicating that there are no issues or shortcomings present.
Any individual or entity affected by the situation described in complaint IN00440352 is required to file the complaint.
To fill out the complaint, the filer should provide their contact information, a detailed description of the alleged issue, any supporting documentation, and submit the completed form to the appropriate authority.
The purpose of the complaint is to formally address and document the absence of deficiencies, ensuring records are kept for transparency and accountability.
The complaint must report the complainant's details, a clear statement of the issue, evidence supporting the no deficiencies claim, and any relevant dates or interactions.
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