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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:15C000101305/17/2017FORM
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This visit is for conducting a routine inspection of the facility.
The facility manager or designated representative is required to file this visit.
The visit report must be completed online through the designated portal, providing details of the inspection findings.
The purpose of this visit is to ensure compliance with regulations and standards set by the governing body.
Information such as date of inspection, specific areas inspected, any violations found, corrective actions taken, and signatures of the inspector and facility representative must be reported.
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