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PRINTED: 12/09/2016 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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The assessment form facility must is a document used to evaluate the conditions of a particular facility or establishment.
All businesses or organizations that operate facilities must file an assessment form.
The assessment form must be filled out accurately and completely, with detailed information about the facility's condition.
The purpose of the assessment form is to ensure that facilities are meeting safety and health standards.
Information such as the facility's location, size, operational status, and any safety hazards must be reported.
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