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PRINTED: 05/13/2020 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:ASHKENAZI HEALTH (X4) ID PREFIX
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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 or designated representative is required to file this visit.
How to fill out this visit was for?
The visit report must be completed by documenting observations, findings, and any corrective actions taken.
What is the purpose of this visit was for?
The purpose of this visit was to ensure compliance with regulations and maintain a safe working environment.
What information must be reported on this visit was for?
Information such as date and time of visit, areas inspected, violations found, and corrective actions taken must be reported.
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