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PRINTED: 07/07/2021 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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Gather all necessary documents and information related to the site visit.

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Any organization or individual looking to assess the condition, compliance, or performance of a physical location or facility may need an unannounced on-site visit.

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What is an unannounced on site?

An unannounced on site is when an inspection or visit is conducted without prior notice.

Who is required to file an unannounced on site?

Any organization or individual that is subject to regulatory compliance may be required to file an unannounced on site.

How to fill out an unannounced on site?

To fill out an unannounced on site, relevant information about the inspection or visit must be recorded accurately.

What is the purpose of an unannounced on site?

The purpose of an unannounced on site is to ensure compliance with regulations, identify any violations, and improve overall performance.

What information must be reported on an unannounced on site?

The information reported on an unannounced on site may include date and time of inspection, findings, corrective actions, and any follow-up steps.

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