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PRINTED: 06/14/2022
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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What is form investigation of complaint?
Form investigation of complaint is a document used to report and investigate complaints or allegations of misconduct or wrongdoing.
Who is required to file form investigation of complaint?
Any individual who has knowledge of or suspects misconduct or wrongdoing is required to file form investigation of complaint.
How to fill out form investigation of complaint?
Form investigation of complaint can be filled out by providing details of the complaint or allegation, including dates, times, locations, and any supporting evidence.
What is the purpose of form investigation of complaint?
The purpose of form investigation of complaint is to investigate and address complaints or allegations of misconduct in a timely and fair manner.
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Information such as the nature of the complaint, names of individuals involved, supporting evidence, and any witnesses must be reported on form investigation of complaint.
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