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PRINTED: 02/06/2023 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:(X3) DATE SURVEY COMPLETED(X2)

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How to fill out brynn-marr-cms-plan-of-correction-signature-page

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Obtain a copy of the Brynn-Marr CMS Plan of Correction Signature Page.

02

Fill out the required fields such as facility name, date of submission, survey date, citation number, and description of deficiency.

03

Sign and date the form to certify the accuracy of the information provided.

04

Submit the completed form to the appropriate regulatory agency or oversight body.

Who needs brynn-marr-cms-plan-of-correction-signature-page?

01

Healthcare facilities and organizations that have received citations or deficiencies from regulatory agencies and need to submit a plan of correction.

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What is brynn-marr-cms-plan-of-correction-signature-page?

It is a document that outlines the corrections that need to be made to comply with CMS regulations.

Who is required to file brynn-marr-cms-plan-of-correction-signature-page?

The healthcare facility or provider that is found to be in violation of CMS regulations.

How to fill out brynn-marr-cms-plan-of-correction-signature-page?

The document must be completed with details of the violations found and the steps that will be taken to correct them.

What is the purpose of brynn-marr-cms-plan-of-correction-signature-page?

The purpose is to ensure that healthcare facilities or providers address and correct any violations of CMS regulations.

What information must be reported on brynn-marr-cms-plan-of-correction-signature-page?

Details of the violations found, the steps that will be taken to correct them, and the timeline for completion.

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