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Printed: 06/21/2024 Form Approved OMB No. 09380391Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIA
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01
Obtain the form from Farmersville Health and Rehabilitation.
02
Fill out personal information including name, date of birth, address, and contact information.
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Provide medical history including current medications, allergies, and any pre-existing conditions.
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Indicate reason for seeking rehabilitation services.
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Sign and date the form before submitting it to the facility.

Who needs farmersville health and rehabilitation?

01
Individuals who require rehabilitation services after an injury or surgical procedure.
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People who need assistance with activities of daily living and physical therapy.
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Patients with chronic conditions requiring ongoing care and monitoring.
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Farmersville Health and Rehabilitation is a facility that provides healthcare services and rehabilitation programs to individuals in need of medical assistance.
Healthcare providers, caregivers, or individuals responsible for the care of patients at the facility are required to file farmersville health and rehabilitation.
Farmersville health and rehabilitation can be filled out by providing relevant medical and personal information about the patient, including their medical history, current health status, and any medications they are taking.
The purpose of farmersville health and rehabilitation is to provide comprehensive healthcare services and rehabilitation programs to help individuals recover from medical conditions and improve their overall well-being.
Information such as patient demographics, medical history, current health status, medications, treatments, and progress notes must be reported on farmersville health and rehabilitation forms.
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