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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:15000107/29/2015FORM
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What is this visit was for?
This visit was for an assessment of the facilities.
Who is required to file this visit was for?
The facility manager is required to file this visit.
How to fill out this visit was for?
The visit should be filled out with details of the assessment findings.
What is the purpose of this visit was for?
The purpose of this visit was to ensure compliance with safety regulations.
What information must be reported on this visit was for?
The report must include observations, recommendations, and corrective actions.
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