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01/02/2019PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICESFORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION
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What is initial statement?
The initial statement is a document that provides basic information about an entity, such as its name, address, and purpose.
Who is required to file initial statement?
The entity's representatives or designated individuals are required to file the initial statement.
How to fill out initial statement?
The initial statement can be filled out online or submitted in person at the appropriate office.
What is the purpose of initial statement?
The purpose of the initial statement is to create a record of the entity's existence and provide information for public transparency.
What information must be reported on initial statement?
Information such as the entity's name, address, purpose, and contact information must be reported on the initial statement.
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