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PRINTED: 10/12/2011 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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What is this visit was for?
This visit was for conducting a routine inspection.
Who is required to file this visit was for?
The department supervisor is required to file this visit.
How to fill out this visit was for?
This visit should be filled out electronically using the designated form.
What is the purpose of this visit was for?
The purpose of this visit was to ensure compliance with regulations and standards.
What information must be reported on this visit was for?
Information regarding safety measures, equipment maintenance, and employee training must be reported.
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