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PRINTED: 11/21/2018
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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What is survey date 111918?
Survey date 111918 refers to the specific date of November 19, 2018.
Who is required to file survey date 111918?
Any individual or entity that was required to participate in the survey on November 19, 2018 is required to file survey date 111918.
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The survey date 111918 should be filled out by providing accurate and complete information as requested in the survey form for November 19, 2018.
What is the purpose of survey date 111918?
The purpose of survey date 111918 is to collect specific data or information relevant to the date of November 19, 2018 for analysis or reporting purposes.
What information must be reported on survey date 111918?
The information reported on survey date 111918 may vary depending on the specific requirements of the survey, but typically include data related to activities or events on November 19, 2018.
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