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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:15E18708/28/2015FORM

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What is this visit was for?

This visit was for a routine inspection by the health department.

Who is required to file this visit was for?

The restaurant owner or manager is required to file this visit.

How to fill out this visit was for?

The visit can be filled out online using the health department's portal.

What is the purpose of this visit was for?

The purpose of the visit is to ensure that the restaurant is in compliance with health codes and regulations.

What information must be reported on this visit was for?

The report must include details of food handling practices, cleanliness of the kitchen, and maintenance of equipment.

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