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PRINTED: 01/26/2021 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION

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How to fill out this visit was for

01

Start by gathering all the required information and documents for the visit, such as identification, appointment details, and any relevant medical records or paperwork.

02

Arrive at the location of the visit on time and check-in with the reception or front desk.

03

Follow any instructions or directions given by the staff, such as completing any necessary forms or providing additional information.

04

Be prepared to answer questions about your medical history, current symptoms, or any specific concerns you may have.

05

Listen carefully to the healthcare provider and provide accurate and detailed information when needed.

06

If any tests or procedures are required during the visit, follow the instructions provided and ask any necessary questions to fully understand the process.

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Before leaving, confirm any next steps or follow-up appointments that may be necessary.

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Follow any post-visit instructions provided by the healthcare provider, such as taking prescribed medications or scheduling further tests.

Who needs this visit was for?

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This visit can be for anyone in need of medical or healthcare services.

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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 facility manager is required to file this visit.

How to fill out this visit was for?

This visit should be filled out using the online reporting portal.

What is the purpose of this visit was for?

The purpose of this visit is to ensure compliance with regulatory standards.

What information must be reported on this visit was for?

All findings from the inspection must be reported.

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