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PRINTED: 02/05/2016 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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Complaint in00192001 - substantiated is a formal document outlining a specific issue or concern that has been proven to be true.
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The individual or organization who has evidence or information regarding the substantiated complaint is required to file it.
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To fill out complaint in00192001 - substantiated, one must provide detailed description of the issue, evidence supporting the claim, and any relevant information.
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Information such as details of the complaint, supporting evidence, dates, and names of individuals involved must be reported on complaint in00192001 - substantiated.
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