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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:15549010/28/2013FORM
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What is this visit was for?
This visit is for a routine inspection by the health department.
Who is required to file this visit was for?
The business owner or manager is required to file this visit.
How to fill out this visit was for?
The visit should be documented in the logbook provided by the health department.
What is the purpose of this visit was for?
The purpose of this visit is to ensure compliance with health and safety regulations.
What information must be reported on this visit was for?
The information reported should include date of visit, inspector's name, findings, and any required actions.
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