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PRINTED: 12/30/2008 FORM APPROVED OMB NO 09380391DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES (XL) PROVIDERISUPPLIERlCLIA IDENTIFICATION NUMBER:STATEMENT OF DEFICIENCIES

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Review the survey form carefully and make sure you understand each question

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Fill out all required fields accurately

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Provide detailed and specific information where necessary

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Be honest and transparent in your responses

05

Ask for assistance from the hospice staff if you have any doubts or questions

Who needs hospice survey and deficiencies?

01

Hospices that want to assess their quality of care and services

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Regulatory bodies that oversee hospice facilities and need to monitor compliance

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Patients and their families who want to provide feedback on their hospice experience

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What is hospice survey and deficiencies?

Hospice survey and deficiencies refer to an assessment and documentation of the quality of care provided by hospice organizations, including any areas where improvement is needed.

Who is required to file hospice survey and deficiencies?

Hospice organizations are required to file hospice survey and deficiencies.

How to fill out hospice survey and deficiencies?

Hospice survey and deficiencies can be filled out by collecting and documenting information on the quality of care provided, identifying any deficiencies, and developing plans for improvement.

What is the purpose of hospice survey and deficiencies?

The purpose of hospice survey and deficiencies is to ensure that hospice organizations are providing high quality care to their patients and to identify areas where improvements can be made.

What information must be reported on hospice survey and deficiencies?

Information on the quality of care provided, any deficiencies identified, and plans for improvement must be reported on hospice survey and deficiencies.

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