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PRINTED: 01/13/2016 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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Step 1: Gather all relevant information about the complaint, including any supporting documentation or evidence.
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Step 2: Clearly identify the parties involved in the complaint, such as the complainant and the respondent.
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Step 3: Write a detailed description of the complaint, including the specific allegations and incidents.
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Step 4: Outline the timeline of events related to the complaint, noting any dates and times that are relevant.
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Step 5: Conduct thorough interviews with the complainant, witnesses, and any other relevant individuals.
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Step 10: Make recommendations for any necessary actions or resolutions based on the investigation results.

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Original investigation of complaint is the initial process of examining and addressing a complaint or allegation.
The party or individual who is the subject of the complaint is usually required to file the original investigation of complaint.
The original investigation of complaint should be filled out completely and accurately, providing all relevant information and supporting documentation.
The purpose of the original investigation of complaint is to address and resolve the issues raised in the complaint, and to ensure a fair and objective outcome.
The original investigation of complaint should include details of the complaint, any evidence or documentation related to the complaint, and contact information for all parties involved.
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