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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:15576306/23/2016FORM
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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 manager in charge of the facility.
How to fill out this visit was for?
The visit report must be completed accurately and submitted to the regulatory agency.
What is the purpose of this visit was for?
The purpose of this visit is to ensure compliance with safety regulations.
What information must be reported on this visit was for?
The visit report must include details of any violations found and actions taken to address them.
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