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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:15C000108709/09/2015FORM
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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 manager or designated representative is required to file this visit.
How to fill out this visit was for?
The visit must be filled out using the official inspection form provided by the regulatory agency.
What is the purpose of this visit was for?
The purpose of this visit is to ensure compliance with health and safety regulations.
What information must be reported on this visit was for?
The report must include details of any violations found during the inspection and the corrective actions taken.
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