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10/04/2022PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICESFORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/CLIAAND PLAN OF CORRECTIONIDENTIFICATION

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Locate the licensure survey form either online or in print.

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Who needs licensure survey completed on?

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Individuals who are applying for a professional license or certification may need to complete a licensure survey.

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Employers or regulatory bodies may also require individuals to fill out a licensure survey as part of the application process.

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What is licensure survey completed on?

Licensure surveys are completed on healthcare facilities or organizations to ensure they meet specific regulatory standards and requirements for operation.

Who is required to file licensure survey completed on?

Healthcare providers and organizations, such as hospitals, nursing homes, and other licensed facilities, are required to file licensure surveys.

How to fill out licensure survey completed on?

To fill out a licensure survey, organizations should gather required information, ensure compliance with regulations, complete the necessary forms accurately, and submit them by the specified deadline.

What is the purpose of licensure survey completed on?

The purpose of a licensure survey is to verify that healthcare facilities comply with state and federal regulations to ensure patient safety and quality of care.

What information must be reported on licensure survey completed on?

Information that must be reported includes facility details, operational practices, staffing levels, patient care protocols, and compliance with health and safety regulations.

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