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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:15554611/12/2013FORM
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This visit was for an inspection of the facility.
The facility manager or designated representative is required to file the visit report.
The visit report should be filled out completely and accurately, including details of the inspection findings.
The purpose of the visit was to ensure compliance with regulations and standards.
Information such as date of visit, inspector's name, inspection findings, corrective actions taken, and follow-up plan must be reported.
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