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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:15573610×30/2014FORM
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Start by entering the date of the visit.
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Provide the purpose or reason for the visit.
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Fill in the name and contact details of the person who made the visit.
04
If applicable, mention the name and contact details of the person or entity being visited.
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What is this visit was for?
This visit was for a routine inspection of the building.
Who is required to file this visit was for?
The building owner or property manager is required to file this visit.
How to fill out this visit was for?
The visit should be filled out by providing details of the inspection findings and any necessary actions taken.
What is the purpose of this visit was for?
The purpose of this visit was to ensure the building is up to code and safe for occupants.
What information must be reported on this visit was for?
Information such as inspection findings, corrective actions taken, and any recommendations for improvements must be reported.
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