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PRINTED: 03/15/2023 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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Read the instructions provided with the survey to understand the purpose and guidelines.

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Provide accurate and detailed information about your complaint or issue in the survey.

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Anyone who has had a negative experience with a product or service and wants to provide feedback to the company.

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What is a complaint survey was?

A complaint survey is a formal report or questionnaire used to gather feedback or complaints from individuals.

Who is required to file a complaint survey was?

Any individual who has experienced a negative experience or has feedback to share.

How to fill out a complaint survey was?

A complaint survey can be filled out online, in person, or over the phone following the instructions provided.

What is the purpose of a complaint survey was?

The purpose of a complaint survey is to gather feedback, address issues, and improve the quality of service.

What information must be reported on a complaint survey was?

The information reported on a complaint survey may include details of the complaint, contact information, and any supporting documentation.

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