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PRINTED: 04/02/2018 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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Submit the completed application to the admissions office at the care facility in person or by mail.

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Unique residential care is a type of residential care facility that provides specialized services to individuals with specific needs or conditions.
Any individual or organization that operates a unique residential care facility is required to file.
To fill out unique residential care, you must provide detailed information about the facility, services provided, and the residents.
The purpose of unique residential care is to ensure that individuals with specific needs receive the specialized services they require in a safe and supportive environment.
Information such as the facility's address, services provided, number of residents, staff qualifications, and safety procedures must be reported on unique residential care.
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