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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:15C000108605/13/2019FORM

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What is this visit was for?

This visit was for a routine inspection.

Who is required to file this visit was for?

The facility manager is required to file this visit.

How to fill out this visit was for?

The visit report should be completed with all relevant information.

What is the purpose of this visit was for?

The purpose of the visit was to ensure compliance with health and safety regulations.

What information must be reported on this visit was for?

All findings from the inspection must be reported, along with any corrective actions taken.

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