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Get Request For Agency Action/license Application - Utah Department Of ... - Health Utah

Print Form PO BOX 144103 SALT LAKE CITY UT 84114-4103 801 538-6158 800 662-4157 toll free 801 538-6163 Fax UTAH DEPARTMENT OF HEALTH DIVISION OF FAMILY HEALTH AND PREPAREDNESS BUREAU OF HEALTH FACILITY LICENSING CERTIFICATION AND RESIDENT ASSESSMENT Version 02/14/2012 REQUEST FOR AGENCY ACTION/LICENSE APPLICATION A.

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