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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:15517805/30/2013FORM

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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 designated department supervisor is required to file this visit.

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The visit should be filled out using the designated form provided by the department.

What is the purpose of this visit was for?

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

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The information reported should include date of visit, areas inspected, findings, and actions taken.

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