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PRINTED: 02/11/2014 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 was for a routine inspection.

Who is required to file this visit was for?

The company's compliance officer 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 was to ensure compliance with regulations.

What information must be reported on this visit was for?

The information reported must include details of any violations found during the inspection.

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