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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:15K01111/21/2017FORM
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To fill out this visit report, follow these steps:
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Start by entering the date of the visit.
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Provide the name and contact details of the person or organization visited.
04
Specify the purpose of the visit and any relevant information about the meeting or event.
05
Include details of the activities conducted during the visit, such as discussions, presentations, or observations.
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What is this visit was for?
This visit was for a routine inspection.
Who is required to file this visit was for?
The site manager is required to file this visit report.
How to fill out this visit was for?
The visit report can be filled out online using the designated portal.
What is the purpose of this visit was for?
The purpose of this visit was to ensure compliance with regulations.
What information must be reported on this visit was for?
The report must include details on any findings and corrective actions taken.
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