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08/06/2020PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICESFORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION
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Start by reviewing the instructions provided with the state licensure survey form.
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Gather all the necessary information and documents that will be required to fill out the survey form.
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Read each question carefully and provide accurate and truthful answers.
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Who needs state licensure survey?

01
State licensure surveys are typically required by individuals or organizations seeking to obtain or renew a professional license issued by the state authority.
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This may include healthcare professionals such as doctors, nurses, therapists, or pharmacists, as well as professionals in other industries such as real estate agents, lawyers, or contractors.
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The specific requirements for the state licensure survey may vary depending on the profession and the state in which the license is sought.
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It is advisable to consult the regulatory or licensing board of the specific profession and state to determine if a state licensure survey is required and to obtain the appropriate survey form.
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State licensure survey is a form that collects information about professional licenses held by individuals.
Individuals holding professional licenses are required to file state licensure survey.
State licensure survey can be filled out online or by mailing in a paper form with accurate information about professional licenses held.
The purpose of state licensure survey is to track and maintain accurate records of professional licenses held by individuals in the state.
Information such as license number, issuing authority, expiration date, and any disciplinary actions must be reported on state licensure survey.
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