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Description of ahca form 3020
AHCA Form 3020 Medical or Clinic Director s or Owner s Representative Signature Title Date If continuation sheet 1 of 1 State Form. Agency for Health Care Administration Statement of Deficiencies and Plan of Correction Health Care Clinic File Number Initial Licensure Renewal CHOW Provisional Name of Clinic U-000 Date Survey Completed Street Address City State ZIP Code SUMMARY STATEMENT OF DEFICIENCIES EACH...
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ahca form 3020
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