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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:15C000104704/03/2017FORM

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What is this visit was for?

This visit was for inspection purposes.

Who is required to file this visit was for?

The business owner or authorized representative is required to file this visit.

How to fill out this visit was for?

The visit must be filled out accurately and completely with all relevant information.

What is the purpose of this visit was for?

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

What information must be reported on this visit was for?

Information such as the date of visit, inspection findings, corrective actions taken, and signatures of parties involved must be reported.

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