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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CIA AND PLAN OF CORRECTION IDENTIFICATION NUMBER: 06/29/2016

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What is this visit was for?

This visit is for conducting an inspection of the facility.

Who is required to file this visit was for?

The facility manager or owner is required to file this visit.

How to fill out this visit was for?

The visit should be filled out by providing detailed information about the inspection findings.

What is the purpose of this visit was for?

The purpose of this visit is to ensure compliance with regulations and standards.

What information must be reported on this visit was for?

The information reported should include any violations found, corrective actions taken, and recommendations for improvement.

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