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PRINTED: 12/13/2023 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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How to fill out and state licensure survey

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Begin by carefully reading the instructions provided with the licensure survey

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Fill out each section of the survey accurately and completely

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Who needs and state licensure survey?

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Individuals seeking to obtain or renew a state licensure, such as healthcare professionals or contractors, may need to fill out and submit a state licensure survey.

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What is and state licensure survey?

A state licensure survey is an evaluation conducted by state authorities to ensure that health care facilities comply with applicable laws and regulations for licensing.

Who is required to file and state licensure survey?

Health care facilities, such as hospitals, nursing homes, and other medical institutions, are typically required to file a state licensure survey.

How to fill out and state licensure survey?

To fill out a state licensure survey, facilities must follow the guidelines provided by the state health department, submitting necessary documentation and completing prescribed forms accurately.

What is the purpose of and state licensure survey?

The purpose of a state licensure survey is to assess compliance with state regulations, ensure patient safety, and maintain the quality of care in health care facilities.

What information must be reported on and state licensure survey?

Information that must be reported includes facility operation details, patient care practices, staffing information, and adherence to safety protocols.

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