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PRINTED: 02/19/2018 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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What is form investigation of complaint?

Form investigation of complaint refers to the documentation required to officially report a complaint and begin the investigative process.

Who is required to file form investigation of complaint?

Any individual or entity who has a complaint that they want to be formally investigated is required to file the form.

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The form typically requires information about the complainant, the nature of the complaint, any supporting evidence, and contact information for follow-up.

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