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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:15G59907/23/2015FORM

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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 visit was required to be filed by the facility manager.

How to fill out this visit was for?

The visit should be filled out by providing detailed information about the inspection findings.

What is the purpose of this visit was for?

The purpose of this visit was to ensure compliance with regulations and standards.

What information must be reported on this visit was for?

The information reported should include the date of the inspection, areas inspected, findings, and any recommended actions.

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