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PRINTED: 09/20/2017 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION

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How to fill out this plan of correction

01

Review the areas of non-compliance identified in the inspection report.

02

Create a detailed action plan for each area of non-compliance, including specific steps to address the issues.

03

Assign responsibilities to team members for each action item in the plan.

04

Set deadlines for completing each action item and establish a timeline for implementing the entire plan.

05

Make sure to document all actions taken to address the non-compliance issues.

06

Submit the completed plan of correction to the appropriate regulatory agency for review.

Who needs this plan of correction?

01

Any organization or facility that has been cited for non-compliance during an inspection and is required to submit a plan of correction.

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What is this plan of correction?

This plan of correction is a document that outlines the steps or actions to be taken to address and rectify deficiencies or violations found during an inspection or audit.

Who is required to file this plan of correction?

The party or organization that was cited for the deficiencies or violations is required to file this plan of correction.

How to fill out this plan of correction?

The plan of correction should include a description of the deficiencies or violations, the proposed corrective actions, a timeline for completion, and any supporting documentation.

What is the purpose of this plan of correction?

The purpose of this plan of correction is to ensure that the identified deficiencies or violations are promptly addressed and corrected to maintain compliance with regulations or standards.

What information must be reported on this plan of correction?

The plan of correction must include details of the deficiencies or violations, proposed corrective actions, responsible parties, timelines for completion, and any supporting documentation.

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