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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:15523407/25/2013FORM
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Gather all necessary documents such as identification, insurance information, and medical history.
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What is this visit was for?
This visit was for a routine inspection of the facility.
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 should be documented in a detailed report and submitted to the appropriate regulatory body.
What is the purpose of this visit was for?
The purpose of this visit was to ensure compliance with 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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