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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:15573601/08/2014FORM
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What is this visit is for?
This visit is for a routine inspection of the facility.
Who is required to file this visit is for?
The facility manager or designated representative is required to file this visit.
How to fill out this visit is for?
The visit can be filled out online through the designated portal or in person with the inspector.
What is the purpose of this visit is for?
The purpose of this visit is to ensure compliance with safety regulations and standards.
What information must be reported on this visit is for?
The report must include details of any violations found, corrective actions taken, and future prevention plans.
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