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PRINTED: 04/10/2018 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 information about the location and previous visit.

02

Schedule a date for the unannounced revisit.

03

Arrive at the location at the scheduled time without informing anyone beforehand.

04

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Who needs an unannounced revisit to?

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Any location or establishment that needs to be evaluated without prior notice.

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What is an unannounced revisit to?

An unannounced revisit is a follow-up inspection or visit that is conducted without prior notice.

Who is required to file an unannounced revisit to?

The entity or individual that is subject to inspection or visit is required to file an unannounced revisit.

How to fill out an unannounced revisit to?

To fill out an unannounced revisit, the required information must be correctly documented and submitted to the relevant authority.

What is the purpose of an unannounced revisit to?

The purpose of an unannounced revisit is to ensure compliance with regulations and standards set by the governing body.

What information must be reported on an unannounced revisit to?

The information reported on an unannounced revisit typically includes observations, findings, and any corrective actions taken.

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