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PRINTED: 01/28/2022 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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Form investigation of complaint is a document used to report any issues, concerns, or complaints related to a specific situation or incident.
Anyone who has witnessed or been directly involved in a situation that requires investigation can file a form investigation of complaint.
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The purpose of form investigation of complaint is to document and investigate any issues or complaints in a formal and structured manner, in order to address them appropriately.
Information such as the date, time, location, individuals involved, description of the incident, and any supporting evidence or documentation must be reported on form investigation of complaint.
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