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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTIONPRINTED:11/9/2020 FORM APPROVED OMB NO. 09380391 (X3) DATE SURVEY COMPLETED(X1)

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How to fill out nursing home survey report

01

Gather all necessary information and documentation required to complete the survey report.

02

Follow the instructions provided in the survey form carefully.

03

Provide detailed and accurate information about the nursing home's facilities, staff, and services.

04

Include any observations or comments about the quality of care provided at the nursing home.

05

Ensure that all sections of the survey report are completed thoroughly and that any required signatures are obtained.

Who needs nursing home survey report?

01

Nursing home administrators

02

Healthcare professionals

03

Government regulatory agencies

04

Insurance companies

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What is nursing home survey report?

Nursing home survey report is a detailed document that provides information about the quality of care and services provided in a nursing home. It includes findings from inspections, complaints, and other assessments.

Who is required to file nursing home survey report?

Nursing home administrators and owners are required to file the nursing home survey report.

How to fill out nursing home survey report?

To fill out the nursing home survey report, administrators and owners must provide accurate information about the facility's operations, staffing, resident care, and compliance with regulations.

What is the purpose of nursing home survey report?

The purpose of the nursing home survey report is to ensure that nursing homes are providing quality care and services to residents and to identify areas where improvements may be needed.

What information must be reported on nursing home survey report?

The nursing home survey report must include information about staffing levels, resident care plans, medication management, infection control practices, and overall compliance with state and federal regulations.

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