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PRINTED: 08/14/2019 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 relevant information related to the complaint
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Document the details of the complaint including dates, times, and individuals involved
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Identify any potential witnesses or evidence that may support the complaint
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Submit the complaint to the appropriate department or individual for investigation
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Follow up on the investigation to ensure it is being handled properly and in a timely manner
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Review the findings of the investigation and take appropriate actions based on the results

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Anyone who has experienced a grievance, misconduct, or inappropriate behavior that needs to be addressed
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A complaint investigation is a formal procedure to examine claims or allegations made by individuals or entities regarding misconduct, failure to comply with regulations, or grievances against a party.
Any individual or entity that has experienced or witnessed misconduct or a violation of rules or regulations may file a complaint investigation.
To fill out a complaint investigation, one typically needs to provide personal details, a description of the complaint, any relevant evidence or documentation, and any witness information in the designated format or form provided by the investigating authority.
The purpose of a complaint investigation is to ensure accountability, promote compliance with laws and regulations, and provide a fair process for resolving grievances.
Information that must be reported includes the complainant's contact details, details of the incident, any evidence supporting the complaint, and the desired outcome or resolution sought by the complainant.
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