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PRINTED: 11/18/2014 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:ST JOSEPH HOSPITAL (X4) ID PREFIX

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Start by entering the date of the visit in the specified field.

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What is this visit was for?

This visit was for a routine inspection of the facility.

Who is required to file this visit was for?

The facility manager or designated representative is required to file this visit.

How to fill out this visit was for?

The visit report should be completed and submitted online through the designated portal.

What is the purpose of this visit was for?

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

What information must be reported on this visit was for?

The visit report must include details of any violations found, corrective actions taken, and recommendations for improvement.

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