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PRINTED: 03/26/2021 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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Form investigation of complaint is a document used to report a complaint or issue to the relevant authorities for further investigation.
Any individual or organization who has a complaint or issue that needs to be investigated is required to file form investigation of complaint.
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The purpose of form investigation of complaint is to prompt an investigation into a reported complaint or issue and to take necessary actions to resolve it.
Information such as details of the complaint, names of individuals involved, dates, any supporting evidence, and contact information must be reported on form investigation of complaint.
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