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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:15156211/20/2017FORM
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To fill out a licensure survey, follow these steps: 1. Obtain a copy of the survey form from the appropriate licensing authority or organization.
02
Read the instructions provided on the form carefully to understand the requirements and guidelines for filling it out.
03
Gather all the necessary information and documents that will be required for the survey. This may include personal identification documents, qualification certificates, work experience records, and any other relevant documents.
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Start filling out the survey form by providing accurate and detailed information. Ensure that you answer all the questions thoroughly and provide supporting evidence wherever required.
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Double-check your responses before submitting the survey form to ensure accuracy and completeness.
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Submit the completed survey form as per the instructions provided. This may involve sending it through mail, submitting it online, or hand-delivering it to the relevant authority or organization.
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Keep a copy of the completed survey form for your records in case it is needed in the future.

Who needs and licensure survey conducted?

01
A licensure survey is typically conducted for individuals or professionals who are seeking or maintaining a specific licensure or certification. This may include healthcare professionals such as doctors, nurses, and pharmacists, as well as professionals in regulated sectors such as engineering, architecture, or education.
02
The purpose of a licensure survey is to assess the qualifications, competence, and adherence to professional standards of the individuals seeking licensure. It helps regulatory bodies or licensing authorities to ensure that professionals meet the required criteria and are qualified to practice in their respective fields.
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A licensure survey is conducted to ensure that professionals are meeting the requirements set by their licensing board or regulatory body.
Professionals who hold a license in a particular field are required to participate in a licensure survey.
Professionals can fill out a licensure survey by providing accurate and up-to-date information about their practice and qualifications.
The purpose of a licensure survey is to assess the competence and qualifications of professionals in a specific field.
Typically, professionals are required to report their education, work experience, training, and any continuing education completed.
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