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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:15G74607/10/2017FORM

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What is this visit was for?

This visit was for a routine inspection of the facility.

Who is required to file this visit was for?

The visit must be filed by the facility manager or designated representative.

How to fill out this visit was for?

The visit can be filled out online using the facility's unique login credentials.

What is the purpose of this visit was for?

The purpose of the visit is to ensure compliance with safety and regulatory standards.

What information must be reported on this visit was for?

The information reported must include details of any deviations from regulations, maintenance records, and corrective actions taken.

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