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PRINTED: 03/04/2021 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 this visit was in?
This visit was in reference to a routine inspection.
Who is required to file this visit was in?
The designated representative of the company is required to file this visit.
How to fill out this visit was in?
The visit should be filled out using the official form provided by the authority conducting the inspection.
What is the purpose of this visit was in?
The purpose of this visit was to ensure compliance with safety regulations.
What information must be reported on this visit was in?
The information that must be reported includes the date of the visit, individuals present, findings of the inspection, and any corrective actions required.
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