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PRINTED: 02/14/2012 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION A.
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What is this visit was for?
This visit was for a routine inspection.
Who is required to file this visit was for?
The visit report must be filed by the designated supervisor.
How to fill out this visit was for?
The visit report should be filled out electronically using the designated form.
What is the purpose of this visit was for?
The purpose of this visit is to ensure compliance with the regulations.
What information must be reported on this visit was for?
The visit report must include details about the findings during the inspection.
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