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PRINTED: 06/26/2015 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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Gather all necessary information and documents required for the survey

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Carefully read and understand each question on the survey

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Provide accurate and up-to-date information in each response

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Who needs state licensure survey completed?

01

Healthcare professionals seeking to practice in a specific state

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Healthcare facilities or organizations applying for licensure renewal or accreditation

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What is state licensure survey completed?

The state licensure survey completed is a formal assessment conducted by state regulatory agencies to verify that healthcare facilities and providers meet the required standards for operation and compliance with state laws.

Who is required to file state licensure survey completed?

Healthcare facilities and providers, such as hospitals, nursing homes, and outpatient clinics, are required to file a state licensure survey completed to maintain their operational licenses.

How to fill out state licensure survey completed?

To fill out the state licensure survey completed, organizations should gather all necessary documentation, carefully review the state requirements, complete the survey forms with accurate information, and submit them to the appropriate state agency.

What is the purpose of state licensure survey completed?

The purpose of state licensure survey completed is to ensure that healthcare facilities and providers comply with applicable regulations, ensuring safety, quality of care, and protection of public health.

What information must be reported on state licensure survey completed?

Information that must be reported includes facility details, staff qualifications, operational policies, patient care practices, and any incidents or issues that may affect compliance with state regulations.

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