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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:15550804/04/2016FORM

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What is this visit was for?

This visit was for conducting a routine inspection.

Who is required to file this visit was for?

The department supervisor is required to file this visit.

How to fill out this visit was for?

The visit report form must be completed with all relevant details.

What is the purpose of this visit was for?

The purpose of this visit was to ensure compliance with safety regulations.

What information must be reported on this visit was for?

The information reported must include date of visit, areas inspected, findings, and recommended actions.

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