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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:15502910/24/2017FORM

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What is this visit was for?

This visit was for a routine inspection.

Who is required to file this visit was for?

The department manager is required to file this visit.

How to fill out this visit was for?

The visit report is to be filled out electronically using the provided template.

What is the purpose of this visit was for?

The purpose of this visit was to ensure compliance with safety regulations.

What information must be reported on this visit was for?

The report must include details of any violations found during the inspection.

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