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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:15571611/02/2020FORM
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Arrive at the location of the visit at the scheduled time.
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Follow any instructions given by the healthcare provider or staff.
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Complete any required forms or questionnaires accurately.
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This visit includes a tour of the facility and a meeting with the management team.
All employees who are involved in the operations of the facility are required to file this visit.
To fill out this visit, you must complete the designated form with all the required information.
The purpose of this visit is to ensure compliance with safety regulations and to assess the overall functioning of the facility.
You must report any safety hazards, incidents, or violations observed during the visit.
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