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____________________ SURVEYOR DISCIPLINE ______ ID NUMBER SURVEY TYPE INITIAL ANNUAL FOLLOW-UP FS 400.990 COMPLAINT CCR# ___________________ _________ OTHER _____________ Health Care Clinic Survey Unit Guide Departed Office Tour Began Record Review Began Exited Clinic Arrived at Clinic Tour Ended Record Review Ended 59-33.012 Survey Requirements and Process. (1) The survey process is an onsite inspection and review of the health care clinic facility or administrative office, by authoriz.

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