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PRINTED: 08/26/2024 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:OMB NO. 09380391 (X2) MULTIPLE CONSTRUCTION A. BUILDING ___(X3) DATE SURVEY COMPLETEDC 155363B. WING ___NAME OF PROVIDER OR SUPPLIERSTREET ADDRESS, CITY, STATE, ZIP CODE404 W WILLOW RDWILLOWDALE VILLAGE (X4) ID PREFIX TAG08/20/2024DALE, IN 47523SUMMARY STATEMENT
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What is complaint in00439703 no deficiencies?
Complaint in00439703 no deficiencies refers to a filed complaint that has been reviewed and found to contain no deficiencies or issues that need addressing.
Who is required to file complaint in00439703 no deficiencies?
Typically, any individual or entity affected by a specific issue or incident can file complaint in00439703 no deficiencies, as long as they have relevant information or concerns to report.
How to fill out complaint in00439703 no deficiencies?
To fill out the complaint in00439703 no deficiencies, you should complete the designated form with accurate and complete information regarding your concerns, ensuring to follow all instructions provided.
What is the purpose of complaint in00439703 no deficiencies?
The purpose of complaint in00439703 no deficiencies is to formally document concerns and issues, allowing for review and resolution by the relevant authorities.
What information must be reported on complaint in00439703 no deficiencies?
The information that must be reported includes the complainant's details, specific concerns or issues related to the complaint, supporting evidence if available, and any relevant dates or timelines.
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