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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:15514911/15/2012FORM

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What is this visit was for?

This visit was for a routine inspection of the facility.

Who is required to file this visit was for?

The facility manager or owner is required to file this visit.

How to fill out this visit was for?

You can fill out this visit by documenting the date and time of the inspection, noting any findings or observations, and signing off on the report.

What is the purpose of this visit was for?

The purpose of this visit was to ensure compliance with regulations and identify any potential safety hazards.

What information must be reported on this visit was for?

The information that must be reported on this visit includes details of the inspection, any violations found, and any corrective actions taken.

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