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PRINTED: 08/23/2019 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:GREEN LEAF CARE CENTER (X4)

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How to fill out statement of deficiencies and

01

Review the regulations and guidelines to understand what deficiencies need to be addressed.

02

Visit the facility and conduct a thorough inspection to identify any areas of non-compliance.

03

Gather evidence to support your findings, including photos, documents, and witness statements.

04

Organize your findings in a clear and concise manner, making sure to include specific examples and citations to the regulations.

05

Draft the statement of deficiencies, outlining each deficiency and providing recommendations for corrective action.

06

Submit the statement of deficiencies to the appropriate regulatory agency for review.

Who needs statement of deficiencies and?

01

Healthcare facilities such as hospitals, nursing homes, and assisted living facilities are required to submit a statement of deficiencies to regulatory agencies.

02

Healthcare providers, administrators, and compliance officers involved in overseeing the operations of these facilities may also need to be familiar with the process of filling out a statement of deficiencies.

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What is statement of deficiencies and?

A statement of deficiencies is a report that outlines any violations or non-compliance issues found during an inspection or survey.

Who is required to file statement of deficiencies and?

Healthcare facilities such as hospitals, nursing homes, and clinics are required to file a statement of deficiencies.

How to fill out statement of deficiencies and?

Statement of deficiencies can be filled out by documenting the violations or non-compliance issues found, providing explanations or corrective actions taken.

What is the purpose of statement of deficiencies and?

The purpose of the statement of deficiencies is to ensure that healthcare facilities are in compliance with regulations and providing quality care to patients.

What information must be reported on statement of deficiencies and?

Information such as the specific violations found, corrective actions taken, and any follow-up required must be reported on the statement of deficiencies.

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