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PRINTED: 12/07/2022 DEPARTMENT OF HEALTH AND HUMAN SERVICESFORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 09380391STATEMENT OF DEFICIENCIES AND(X1) PROVIDER/SUPPLIER/CHAPMAN OF CORRECTIONSIDENTIFICATION

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What is this visit was for?

This visit was for the purpose of assessing compliance with regulatory requirements.

Who is required to file this visit was for?

Individuals or entities subject to the regulations applicable to the visit are required to file.

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What is the purpose of this visit was for?

The purpose of this visit was to evaluate adherence to established guidelines and to ensure proper documentation.

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Reported information typically includes data related to compliance status, key personnel, and observed activities during the visit.

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