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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:15538610/06/2020FORM

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What is this visit was for?

This visit was for a routine inspection of the facilities.

Who is required to file this visit was for?

The facility manager or authorized representative is required to file this visit.

How to fill out this visit was for?

The visit should be filled out by providing accurate information about the facilities and any findings during the inspection.

What is the purpose of this visit was for?

The purpose of this visit was to ensure compliance with regulations and standards.

What information must be reported on this visit was for?

Information about the condition of the facilities, any violations found, and corrective actions taken must be reported on this visit.

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