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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION NUMBER:15553209/03/2013FORM

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What is this visit was for?

This visit was for a routine check-up or assessment of health and wellness.

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Individuals who undergo health assessments are required to file this visit.

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To fill out this visit, complete the relevant health assessment forms and provide necessary medical history.

What is the purpose of this visit was for?

The purpose of this visit is to monitor health, identify any potential issues, and ensure overall wellness.

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The information that must be reported includes personal details, medical history, symptoms, and any current medications.

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