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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:15515809/12/2013FORM

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What is this visit was for?

This visit was for conducting a routine inspection.

Who is required to file this visit was for?

The authorized representative of the organization visited is required to file this visit.

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The visit report must be filled out completely and accurately.

What is the purpose of this visit was for?

The purpose of this visit was to ensure compliance with regulations and standards.

What information must be reported on this visit was for?

The findings of the inspection, any violations noted, and any corrective actions taken.

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