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01/28/2025PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICESFORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/CLIAAND PLAN OF CORRECTIONIDENTIFICATION
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Individuals or organizations who have experienced a grievance or issue related to the services or actions governed by IN00447782 – State.
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Complaint in00447782 refers to a formal complaint filed in the state regarding a specific issue or dispute that requires resolution.
Typically, the individual or entity who has been directly affected by the issue described in the complaint is required to file it.
To fill out the complaint, you should provide relevant personal information, details of the grievance, any supporting documents, and ensure you follow the guidelines provided by the state.
The purpose of the complaint is to formally notify the appropriate authorities about the issue and seek resolution or redress.
The complaint must report the complainant's information, a detailed description of the issue, dates and events related to the incident, and any evidence that supports the claim.
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