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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:15G16705/15/2017FORM
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Fill out the date and time of the visit accurately.
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What is this visit was for?
This visit was for a routine inspection of the premises.
Who is required to file this visit was for?
The responsible party in charge of the property is required to file this visit.
How to fill out this visit was for?
To fill out this visit, you need to provide detailed information about the property and any relevant observations or findings.
What is the purpose of this visit was for?
The purpose of this visit is to ensure compliance with regulations and safety standards.
What information must be reported on this visit was for?
Information such as maintenance records, safety checks, and any incidents or accidents must be reported on this visit.
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