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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:15579912/30/2014FORM

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What is this visit was for?

This visit is for a routine inspection by the health department.

Who is required to file this visit was for?

The restaurant owner or manager is required to file this visit.

How to fill out this visit was for?

The visit report must be filled out completely and accurately, documenting any findings or violations.

What is the purpose of this visit was for?

The purpose of this visit is to ensure that the restaurant is complying with health and safety regulations.

What information must be reported on this visit was for?

Information such as cleanliness, food storage, temperature control, and employee hygiene must be reported on this visit.

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