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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CIA AND PLAN OF CORRECTION IDENTIFICATION NUMBER: 155039
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Start by reviewing the purpose of the visit and gather all relevant information. This may include the date and time of the visit, the name of the visitor, the purpose of their visit, and any additional details that need to be recorded.
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f0000 is a form that needs to be filled out for this visit.
Anyone who visited the location is required to file f0000 for this visit.
To fill out f0000 for this visit, you need to provide all the necessary information requested on the form.
The purpose of f0000 for this visit is to keep track of all visitors to the location.
You must report your name, contact information, date and time of the visit, and reason for the visit on f0000 for this visit.
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