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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: 155159
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Begin by identifying the purpose of your visit. Consider if it was for a medical appointment, a business meeting, a personal visit, or another reason.
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What is this visit was for?
This visit was for a routine inspection.
Who is required to file this visit was for?
The facility manager is required to file this visit report.
How to fill out this visit was for?
To fill out this visit report, the facility manager must provide details on the inspection findings and any actions taken.
What is the purpose of this visit was for?
The purpose of this visit was to ensure compliance with safety regulations.
What information must be reported on this visit was for?
The report must include details on the inspection date, findings, and corrective actions taken.
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