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PRINTED: 07/09/2024 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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Form surveyor entered form is a document used to record data collected by a surveyor during a survey.
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The purpose of form surveyor entered form is to document and report the information collected during a survey.
Information such as survey results, location data, and any relevant observations must be reported on form surveyor entered form.
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