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Deficiency Form (17) DHR-DF -19 ALLABAMA DEPARTMENT OF HUMAN RESOURCES CHILD CARE MINIMUM STANDARDS DEFICIENCY REPORT (Additional.Page) Facility Name: WILL-N-HANDS Date of Visit: 110(4 'd.b— SECTION B -DEFICIENCY INFORMATION (Continued) Column 1 Column 2 Minimum Standard Date Corrected by Deficiency Licensee Ub 0w5 ,nnt�sl+n �►Y�sse s. i i i INSTRUCTIONS TO LICENSEE: Column 2,Date Corrected by Licensee, is to b co leted by the facility represent itive a er each deficiency is corrected The facility representative must put the date of correct n a d his/her initials in Column . This form must be returned to the Department of Human Resources on or before $ L� , as verificad n th t deficiencies have been corrected NOTICE: Any misleading or any false statements or reports made to the Department and/or failure to correct t c listed deficiencies can be the basis for adverse action. None of these requirements are to be interpreted to allow anyonc to operate in violation of Minimum Standards. A facility licensed by the Department must meet Minimum Standards applicable to tha f cility at all times. It is the responsibility of the licensee to operate in ompliance with Minimum Standards. t Signature of Facility Representativ - Date Signature of DHR Licensing Representative Date COPIES TO: -PrW\C1Cr �� Page