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PRINTED: 03/17/2020 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:(X3) DATE SURVEY COMPLETED 03/10/2020STREET
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How to fill out a deficiency was cited
How to fill out a deficiency was cited
01
Read the deficiency citation carefully to understand what is required.
02
Compile all necessary documentation or evidence to address the deficiency.
03
Write a detailed response addressing each point raised in the deficiency citation.
04
Provide any additional information or mitigation strategies if necessary.
05
Submit the response within the specified deadline to the relevant authority.
Who needs a deficiency was cited?
01
Anyone who has received a deficiency citation or notice from a regulatory body or authority.
02
Individuals or organizations who are required to comply with specific regulations or standards.
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What is a deficiency was cited?
A deficiency cited is a documented issue or violation found during an inspection or audit.
Who is required to file a deficiency was cited?
The entity or individual responsible for the deficiency is required to file the report.
How to fill out a deficiency was cited?
The deficiency report should be filled out with detailed information about the issue, its cause, and proposed corrective actions.
What is the purpose of a deficiency was cited?
The purpose of a deficiency cited is to identify areas of non-compliance or improvement needed in a process, system, or operation.
What information must be reported on a deficiency was cited?
The report should include details about the deficiency, its impact, root cause analysis, and proposed corrective actions.
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