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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:15G53210/19/2016FORM

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What is this visit was for?

This visit was for a routine inspection.

Who is required to file this visit was for?

The facility manager is required to file this visit.

How to fill out this visit was for?

The visit report must be completed with all relevant information.

What is the purpose of this visit was for?

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

What information must be reported on this visit was for?

The report must include findings, corrective actions, and any recommendations.

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