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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION NUMBER:15G27209/09/2016FORM
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To fill out a licensure survey, follow these steps:
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Review the survey instructions and requirements.
03
Gather all the necessary information and documents related to your licensure.
04
Access the survey platform or website specified in the instructions.
05
Enter your personal details, such as your name, contact information, and license number.
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Answer each question in the survey accurately and honestly.
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Provide any additional information or supporting documents as requested.
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Submit the completed licensure survey.
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Keep a copy of the survey confirmation or receipt for your records.
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Who needs licensure survey conducted on?

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The licensure survey is typically conducted for individuals who hold professional licenses or certifications in a specific field. This may include licensed healthcare professionals, such as doctors, nurses, pharmacists, and therapists. It can also apply to licensed tradespeople, such as electricians, plumbers, and contractors. Additionally, individuals who are renewing their licenses or undergoing recertification may be required to participate in a licensure survey. The specific requirements and individuals targeted for the survey may vary depending on the regulatory body or organization overseeing the licensure process.
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Licensure survey is conducted on healthcare facilities and providers to ensure compliance with licensing requirements.
All healthcare facilities and providers who are licensed or certified to operate in a specific jurisdiction are required to file licensure survey.
Licensure survey can be filled out online through the designated licensing body's website or by submitting physical forms with required information.
The purpose of licensure survey is to monitor and assess the quality of healthcare services provided by licensed facilities and providers.
The information reported on licensure survey may include facility/provider information, patient demographics, services provided, compliance with regulations, and any instances of non-compliance.
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