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PRINTED: 10/27/2017 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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The complaint in00243722-unsubstantiated is due to an unsubstantiated claim or accusation.
Anyone who has information or evidence related to the unsubstantiated claim must file the complaint.
The complaint form must be filled out with all relevant details, including the nature of the claim, any supporting evidence, and contact information.
The purpose of the complaint is to address and investigate the unsubstantiated claim in order to determine its validity.
The complaint must include details about the claim, any evidence or witnesses, and contact information of the individual filing the complaint.
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