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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:06/24/2013FORM

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Gather all necessary documents including any evidence or proof of residency.

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Fill out the form with accurate and detailed information about the state residential finding.

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Who needs substantiated state residential finding?

01

Individuals or families applying for state benefits or assistance that require proof of residence.

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Government agencies or organizations that require verification of a person's state residency.

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What is substantiated state residential finding?

Substantiated state residential finding is a report that confirms the existence of abuse or neglect in a residential facility.

Who is required to file substantiated state residential finding?

The administrator or manager of the residential facility is required to file substantiated state residential finding.

How to fill out substantiated state residential finding?

Substantiated state residential finding can be filled out by providing details of the abuse or neglect incidents, along with any supporting documentation.

What is the purpose of substantiated state residential finding?

The purpose of substantiated state residential finding is to ensure accountability and transparency in residential facilities and to protect vulnerable populations from abuse and neglect.

What information must be reported on substantiated state residential finding?

The report must include details of the abuse or neglect incidents, the individuals involved, and any actions taken by the facility to address the situation.

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