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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:15532304/04/2013FORM
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Start by gathering all the necessary information for the visit, such as date, time, and purpose.
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Arrive at the designated location for the visit and check in or register, if required.
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This visit is for anyone who is required to provide information or complete a form as part of the visit procedure.
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Both new and existing customers, clients, or patients may need to fill out the visit form.
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This visit was for a routine inspection by the health department.
The restaurant owner or manager is required to file this visit report.
The visit report must be filled out online on the health department's website.
The purpose of this visit is to ensure that the restaurant is in compliance with health and safety regulations.
The report must include details of any violations found during the inspection and the corrective actions taken.
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