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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES12/14/2011FORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 09380391STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION

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wwwingov isdh reportsprinted 12142011 is needed by anyone who is required to submit reports to the Indiana State Department of Health (ISDH). This may include healthcare facilities, healthcare professionals, researchers, or anyone else who has a reporting obligation to the ISDH. The specific requirements and reports may vary depending on the type of entity or individual.

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Information such as patient admissions, discharges, infections, and other relevant healthcare data must be reported on wwwingov isdh reportsprinted 1214.

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