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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:15C000105503/25/2014FORM
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What is this visit was for?
This visit was for a routine inspection of the facility.
Who is required to file this visit was for?
The facility supervisor or manager is required to file this visit.
How to fill out this visit was for?
The visit should be documented in the facility's logbook and any findings should be reported to the appropriate authorities.
What is the purpose of this visit was for?
The purpose of this visit was to ensure compliance with safety regulations and standards.
What information must be reported on this visit was for?
The date and time of the visit, the names of the inspectors, any findings or violations, and any corrective actions taken.
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