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PRINTED: 09/01/2015 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION

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How to fill out complaint in00180446 -- substantiated

01

Title the complaint with the case number in00180446

02

Provide a brief overview of the situation or incident being complained about

03

Include any supporting evidence or documentation to substantiate the complaint

04

Clearly outline the reasons why the complaint is being made

05

Conclude the complaint with a statement requesting for a resolution or action to be taken

Who needs complaint in00180446 -- substantiated?

01

Any individual or entity involved in or affected by the situation or incident referenced in case number in00180446 may need to file or be aware of this substantiated complaint

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The complaint in00180446 -- substantiated refers to a complaint that has been investigated and confirmed to be valid.

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The complaint in00180446 -- substantiated must include details of the incident, names of individuals involved, witnesses, and any supporting evidence.

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