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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:15579912/05/2013FORM

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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 personnel is required to file this visit.

How to fill out this visit was for?

The visit must be documented in the inspection log with details of the findings and any corrective actions taken.

What is the purpose of this visit was for?

The purpose of this visit was to ensure compliance with safety regulations and standards.

What information must be reported on this visit was for?

The information reported must include the date of the visit, areas inspected, findings, and actions taken.

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