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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:15557411/14/2017FORM
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To fill out the licensure survey, follow these steps:
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Start by reading the survey instructions carefully.
03
Gather all the required information and documentation related to your licensure.
04
Access the online survey form provided by the surveyor.
05
Enter your personal details such as name, address, contact information, etc.
06
Provide the necessary information about your licensure, including the type of license, license number, issuing authority, etc.
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Answer all the survey questions honestly and accurately.
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If there are any additional comments or explanations required, provide them in the designated section.
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Review your answers before submitting the survey.
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Submit the completed survey form online or follow the specified submission instructions.
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Keep a copy of the submitted survey for your records.
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Wait for any further communication or instructions from the surveyor regarding the survey results or any additional steps.

Who needs licensure survey conducted on?

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Licensure surveys are typically conducted on individuals or entities who hold professional licenses or certifications.
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Some examples of those who may need to participate in a licensure survey include:
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- Doctors, nurses, and other healthcare professionals
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- Architects, engineers, and construction professionals
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- Lawyers and legal professionals
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- Accountants and financial professionals
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- Teachers and educators
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- Real estate agents and brokers
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- Insurance agents and brokers
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- Cosmetologists and beauticians
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These surveys are often conducted by regulatory bodies, professional associations, or other organizations responsible for ensuring the compliance and competence of licensed professionals.
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Licensure survey is conducted on healthcare facilities and providers to ensure compliance with licensing regulations.
Healthcare facilities and providers are required to file licensure surveys.
Licensure surveys can be filled out online or submitted through mail as per instructions provided.
The purpose of licensure survey is to assess and monitor the quality of care provided by healthcare facilities and providers.
Information such as patient care protocols, safety measures, staffing levels, and overall compliance with regulations must be reported on licensure surveys.
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