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PRINTED: 10/22/2020
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 complaint in00339676 - substantiated?
The complaint in00339676 - substantiated is regarding a substantiated issue or concern.
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The person who has knowledge of the substantiated issue or concern is required to file the complaint.
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The complaint in00339676 - substantiated can be filled out by providing details of the substantiated issue or concern, any supporting evidence, and contact information.
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The purpose of the complaint in00339676 - substantiated is to address and resolve the substantiated issue or concern.
What information must be reported on complaint in00339676 - substantiated?
The complaint in00339676 - substantiated must include details of the substantiated issue, any relevant information or evidence, and contact information of the person filing the complaint.
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