Intakes TN00025801, TN00025960, - health state tn 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the provider identification number in the designated field. This is crucial for tracking and referencing your submission.
3. Fill in the name of the provider or supplier along with their complete address, including street, city, state, and ZIP code. Ensure accuracy to avoid processing delays.
4. In the summary statement section, clearly outline any deficiencies noted during the survey. Each deficiency should be accompanied by its regulatory identifying information.
5. Complete the provider's plan of correction by detailing corrective actions for each deficiency. Cross-reference these actions with their respective deficiencies for clarity.
6. Finally, ensure that all signatures are obtained where required and enter the completion date for each action taken.

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