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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:15G01310/16/2014FORM

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What is this visit was for?

This visit was for a routine inspection of the facility.

Who is required to file this visit was for?

The facility manager or designated representative is required to file this visit.

How to fill out this visit was for?

The visit should be accurately documented using the provided forms and following the specific guidelines.

What is the purpose of this visit was for?

The purpose of this visit is to ensure compliance with regulations and standards set by the governing body.

What information must be reported on this visit was for?

Details of any findings, corrective actions taken, and observations made during the visit must be reported.

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