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PRINTED: 07/19/2016 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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The complaint investigation 1642969il 85889 refers to a specific case or issue that is being investigated.
The individual or organization involved in the complaint or issue is required to file the complaint investigation.
To fill out the complaint investigation form, one needs to provide all relevant information and details related to the complaint or issue.
The purpose of the complaint investigation is to gather information, investigate the issue, and come to a resolution or decision.
Information such as details of the complaint, individuals involved, dates, times, and any evidence related to the complaint must be reported.
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