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PRINTED: 01/03/2017 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION
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The document is a long term care facility self-assessment questionnaire.
All long term care facilities are required to fill out and submit the self-assessment questionnaire.
The questionnaire must be completed online through the designated portal provided by the Illinois Department of Public Health.
The purpose of the self-assessment questionnaire is to assess the quality of care and services provided by long term care facilities.
The questionnaire asks for information regarding facility policies, staff training, resident satisfaction, infection control measures, and overall quality improvement initiatives.
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