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PRINTED: 02/18/2022 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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What is form investigation of complaint?

Form investigation of complaint is a formal document used to report a complaint and request an investigation by the appropriate authorities.

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Any individual or organization who has a complaint that they want to be investigated is required to file form investigation of complaint.

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The information reported on form investigation of complaint must include details about the complaint, names of individuals involved, dates, location, and any supporting documentation.

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