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PRINTED: 02/07/2017 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION
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What is this visit was for?
This visit is for conducting a site inspection.
Who is required to file this visit was for?
The site manager is required to file this visit.
How to fill out this visit was for?
The visit should be filled out with detailed information about the site inspection findings.
What is the purpose of this visit was for?
The purpose of this visit is to ensure compliance with safety regulations and standards.
What information must be reported on this visit was for?
Information such as date of inspection, specific findings, corrective actions taken, and signature of inspector must be reported.
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