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PRINTED: 02/13/2017 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:METHODIST HOSPITALS INC (X4) ID

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What is this visit was for?

This visit is for conducting a routine inspection.

Who is required to file this visit was for?

The responsible person in charge of the facility is required to file this visit report.

How to fill out this visit was for?

The visit should be filled out by providing accurate and detailed information about the inspection findings.

What is the purpose of this visit was for?

The purpose of this visit is to ensure compliance with regulations and standards.

What information must be reported on this visit was for?

The report must include details of the inspection process, any violations found, corrective actions taken, and follow-up plans.

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