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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:15519609/11/2012FORM

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1. To fill out the reports on the website http://www.in.gov/isdh/reports, follow these steps:
2. Open your preferred web browser and go to the URL http://www.in.gov/isdh/reports.
3. On the website's homepage, you will find different types of reports available for filling out.
4. Choose the specific report you need to fill out and click on its link.
5. Read the instructions and guidelines provided on the report's page to ensure you understand the requirements.
6. Fill out the necessary information in the designated fields. Make sure to provide accurate and complete information.
7. Review your filled-out report for any errors or missing information.
8. Once you are satisfied with the report, click on the submit button to submit it electronically.
9. You may receive a confirmation message or receipt indicating that your report submission was successful.
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11. If you encounter any issues or have questions while filling out the reports, refer to the contact information provided on the website for further assistance.

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The website http://www.in.gov/isdh/reports contains information about reporting requirements in the state of Indiana.

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