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02/19/2018PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICESFORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION

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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 of the facility is required to file this visit.

How to fill out this visit was for?

The visit report must be completed with details of observations and findings.

What is the purpose of this visit was for?

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

What information must be reported on this visit was for?

The report must include date of visit, inspection findings, and recommended actions.

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