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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:09/11/2014FORM

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What is this visit was for?

This visit was for a compliance check.

Who is required to file this visit was for?

The business owner is required to file this visit.

How to fill out this visit was for?

The visit should be filled out with accurate and detailed information about the compliance activities.

What is the purpose of this visit was for?

The purpose of this visit is to ensure that the business is following all the required regulations and guidelines.

What information must be reported on this visit was for?

The visit must report the date of the visit, the compliance activities conducted, any violations found, and the corrective actions taken.

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