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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:15558007/01/2016FORM

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What is this visit was for?

This visit is for conducting a routine inspection of the premises.

Who is required to file this visit was for?

The site manager or owner is required to file this visit report.

How to fill out this visit was for?

The visit report must be filled out with details of the inspection findings and any corrective actions taken.

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?

The visit report must include details of any violations found, corrective actions taken, and future prevention measures planned.

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