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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:15513712/12/2016FORM
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Begin filling out the form by providing basic details about the visit, such as the name of the person or organization being visited, the visitation date, and the visitation time.
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What is this visit was for?
This visit was for a routine inspection of the facilities.
Who is required to file this visit was for?
The facility manager or designated representative is required to file this visit.
How to fill out this visit was for?
The visit should be filled out by documenting observations and any corrective actions taken during the inspection.
What is the purpose of this visit was for?
The purpose of this visit is to ensure compliance with safety regulations and standards.
What information must be reported on this visit was for?
Information such as date of inspection, areas inspected, findings, and any corrective actions must be reported.
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