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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONPRINTED:4/27/2017 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY COMPLETED(X1)
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Step 1: Gather all necessary information and documents required for the survey report.
02
Step 2: Begin filling out the survey report by providing detailed information about the nursing home being surveyed.
03
Step 3: Answer each question on the survey report accurately and thoroughly. Use specific examples and provide relevant details.
04
Step 4: Follow any specific instructions or guidelines provided in the survey report form.
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Step 5: Review and proofread the completed survey report for any errors or omissions.
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Step 6: Submit the filled-out survey report to the relevant authority or organization responsible for collecting these reports.

Who needs nursing home survey report?

01
Nursing home administrators
02
Staff members responsible for quality assessment and improvement
03
Government regulatory agencies
04
Accreditation organizations
05
Researchers and analysts studying nursing home practices
06
Healthcare consultants evaluating nursing home performance
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Nursing home survey report is a document that provides detailed information about the conditions, quality of care, and compliance of a nursing home with regulations and standards set by authorities.
Nursing home administrators or authorized representatives are required to file the nursing home survey report.
The nursing home survey report can be filled out by providing accurate information about the facility's operations, staffing, resident care, and compliance with regulations.
The purpose of the nursing home survey report is to ensure that nursing homes are providing high-quality care to their residents and are in compliance with regulations.
Information such as staffing levels, resident care practices, facility conditions, and compliance with regulations must be reported on the nursing home survey report.
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