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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES 11/04/2011 FORM APPROVED CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 09380391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CIA AND PLAN OF
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Printed department of health refers to the form or document that contains information on the health status of an individual or a group of individuals.
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Healthcare providers, hospitals, clinics, and other healthcare institutions are required to file printed department of health.
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Information such as patient demographics, medical history, current health conditions, treatments received, and healthcare providers involved must be reported on printed department of health.
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