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PRINTED: 02/11/2025 FORM APPROVEDIllinois Department of Public Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION A.
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The 03052025 form is an approved document submitted to the relevant authorities for specific regulatory compliance or reporting purposes.
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The purpose of the 03052025 form is to ensure compliance with regulatory requirements, to collect data pertinent to industry practices, or to facilitate transparency in reporting financial or operational activities.
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