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PRINTED: 04/21/2014 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:ASB URY TOWERS HEALTH CARE CENTER
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To fill out substantiated federal/state deficiency report, follow these steps:
02
Gather necessary information: Make sure you have all the relevant documents and data related to the deficiency.
03
Identify the deficiency: Clearly specify the deficiency or non-compliance issue that needs to be addressed in the report.
04
Provide details: Document the specifics of the deficiency, including the date, time, location, and any other important details.
05
Describe the impact: Explain the potential consequences or risks associated with the deficiency and why it needs to be rectified.
06
Include supporting evidence: Attach any supporting evidence, such as photographs, witness statements, or data analysis, to validate the deficiency.
07
Suggest corrective actions: Offer potential solutions or recommendations for addressing the deficiency and preventing future occurrences.
08
Submit the report: Follow the designated process for submitting the substantiated federal/state deficiency report to the appropriate authority.
09
Follow-up: If required, monitor the progress of any corrective actions taken based on the report and provide further information or assistance as needed.

Who needs substantiated federalstate deficiency re?

01
Substantiated federal/state deficiency report is usually needed by regulatory agencies, auditors, or compliance officers who are responsible for ensuring adherence to federal or state regulations.
02
Healthcare facilities, educational institutions, businesses in regulated industries, or any organization that needs to demonstrate compliance may require substantiated federal/state deficiency reports.
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Substantiated federalstate deficiency re is a report that documents and provides evidence of deficiencies in federal or state regulations.
Entities or individuals who are subject to federal or state regulations and have identified deficiencies that need to be reported.
Substantiated federalstate deficiency re forms can typically be filled out online or through a paper form provided by the regulating agency.
The purpose of substantiated federalstate deficiency re is to ensure transparency and accountability by reporting and addressing deficiencies in compliance with regulations.
Information such as the nature of the deficiency, affected regulations, actions taken to address the deficiency, and any supporting documentation.
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