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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:15130010/19/2018FORM

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What is this visit was for?

This visit is for the inspection of the premises.

Who is required to file this visit was for?

The visit report must be filed by the appointed compliance officer.

How to fill out this visit was for?

The visit report should be filled out accurately and completely following the guidelines provided.

What is the purpose of this visit was for?

The purpose of this visit is to ensure compliance with regulations and identify any potential health or safety risks.

What information must be reported on this visit was for?

The report must include details of the inspection findings, any violations observed, and recommended actions to address them.

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