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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:15544612/16/2015FORM
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What is this visit was for?
This visit is for a routine inspection of the facility.
Who is required to file this visit was for?
The facility manager or designated representative is required to file this visit.
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The visit should be filled out by providing accurate and detailed information about the inspection.
What is the purpose of this visit was for?
The purpose of this visit is to ensure compliance with health and safety regulations.
What information must be reported on this visit was for?
Information such as date of inspection, findings, corrective actions taken, and follow-up plans must be reported on this visit.
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