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PRINTED: 09/11/2020 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFIC ENVIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA DENT FICTION

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How to fill out statement of deficiencies and

01

Review the survey findings to identify deficiencies

02

Create a plan to address each deficiency

03

Document the corrective actions taken for each deficiency

04

Include evidence to support the corrective actions

05

Submit the completed statement of deficiencies to the appropriate regulatory agency

Who needs statement of deficiencies and?

01

Healthcare facilities, such as hospitals, nursing homes, and home health agencies, are required to complete a statement of deficiencies in order to comply with regulatory requirements.

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What is statement of deficiencies and?

Statement of deficiencies is a document that identifies areas of non-compliance with regulatory requirements.

Who is required to file statement of deficiencies and?

Healthcare facilities such as nursing homes and hospitals are required to file statement of deficiencies.

How to fill out statement of deficiencies and?

Statement of deficiencies should be filled out by identifying non-compliance areas and providing a plan of correction.

What is the purpose of statement of deficiencies and?

The purpose of statement of deficiencies is to ensure that healthcare facilities are meeting regulatory standards and providing quality care.

What information must be reported on statement of deficiencies and?

Information such as non-compliance areas, reasons for non-compliance, and plan of correction must be reported on statement of deficiencies.

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