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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:15562807/03/2014FORM
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What is this visit was for?
This visit was for a routine maintenance check.
Who is required to file this visit was for?
The maintenance supervisor is required to file this visit.
How to fill out this visit was for?
To fill out this visit, the supervisor must report any issues found during the maintenance check.
What is the purpose of this visit was for?
The purpose of this visit was to ensure all equipment is in working order.
What information must be reported on this visit was for?
The supervisor must report any maintenance tasks completed and any issues found.
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