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PRINTED: 11/07/2023 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 an onsite complaint investigation

01
Gather all necessary information related to the complaint, including details of the incident, date, time, and persons involved.
02
Visit the site where the complaint was made and conduct a thorough investigation by interviewing witnesses and collecting evidence.
03
Document all findings and observations in a detailed report, including any recommendations for resolution or follow-up actions.
04
Communicate the results of the investigation to the appropriate parties and ensure that any necessary corrective actions are taken.
05
Follow up with the complainant to address any concerns or questions they may have and ensure that they are satisfied with the outcome of the investigation.

Who needs an onsite complaint investigation?

01
Any organization or individual who has received a complaint alleging misconduct, negligence, or any other violation that requires an onsite investigation to determine the facts and take appropriate action.
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An onsite complaint investigation is a process where a designated individual visits a location to investigate a reported complaint.
Any party involved in the complaint may be required to file an onsite complaint investigation.
To fill out an onsite complaint investigation, provide detailed information about the complaint, location, parties involved, and any evidence supporting the complaint.
The purpose of an onsite complaint investigation is to gather information, assess the situation, and determine if any action needs to be taken to address the complaint.
Information such as the nature of the complaint, location details, individuals involved, evidence supporting the complaint, and any actions taken to address the complaint must be reported on an onsite complaint investigation.
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