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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES OMB NO. 09380391 (X1) PROVIDER/SUPPLIER/CIA AND PLAN OF CORRECTION IDENTIFICATION
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Start by identifying the purpose of your visit. Determine the main reason why you are visiting or seeking assistance, such as a medical check-up, a job interview, a business meeting, or a personal appointment.
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Who needs to know the purpose of your visit?
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What is this visit was for?
This visit is for a routine inspection.
Who is required to file this visit was for?
The inspector assigned to the visit is required to file the information.
How to fill out this visit was for?
The visit should be filled out by providing accurate data and observations during the inspection.
What is the purpose of this visit was for?
The purpose of this visit is to ensure compliance with regulations and standards.
What information must be reported on this visit was for?
Information such as findings, recommendations, and any corrective actions taken must be reported.
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