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PRINTED: 07/10/2019 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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05 - inspection is a form used to report certain information to regulatory authorities.
Entities or individuals who are subject to regulatory requirements related to inspections are required to file 05 - inspection.
05 - inspection can be filled out electronically or manually, following the instructions provided by the regulatory authorities.
The purpose of 05 - inspection is to ensure compliance with regulations and to provide important information to regulatory authorities for monitoring purposes.
Information such as inspection date, findings, corrective actions taken, and any relevant documentation must be reported on 05 - inspection.
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