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This document details the findings from an Emergency Preparedness survey conducted by the Indiana Department of Health for Hickory Creek at New Castle, outlining deficiencies in compliance with Medicare and Medicaid emergency preparedness requirements, and includes a plan of correction proposed by the facility.
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How to fill out cms-2567
How to fill out cms-2567
01
Obtain a copy of the CMS-2567 form.
02
Read the instructions provided on the form carefully.
03
Fill in the identifying information such as the facility's name, address, and provider number.
04
Document the date of the survey or investigation.
05
Clearly list the deficiencies observed in the facility.
06
Provide a citation for each deficiency according to CMS regulations.
07
Include any additional comments or explanations as necessary.
08
Review the form for completeness and accuracy before submission.
09
Submit the completed form to the designated CMS office.
Who needs cms-2567?
01
Healthcare facilities that are subject to CMS surveys and need to report deficiencies.
02
Providers looking to document compliance issues.
03
State survey agencies for reporting findings during inspections.
04
Compliance officers in healthcare organizations.
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What is cms-2567?
CMS-2567 is a form used by healthcare facilities to report deficiencies found during surveys conducted by the Centers for Medicare & Medicaid Services (CMS).
Who is required to file cms-2567?
Healthcare facilities that participate in Medicare or Medicaid programs and are subject to CMS surveys are required to file CMS-2567.
How to fill out cms-2567?
To fill out CMS-2567, facilities must provide details of the deficiencies identified during a survey, including the specific regulatory standards violated and the corrective actions taken.
What is the purpose of cms-2567?
The purpose of CMS-2567 is to document compliance and deficiencies of healthcare facilities to ensure quality of care and adherence to federal regulations.
What information must be reported on cms-2567?
CMS-2567 must report specific deficiencies, including the tag numbers of regulations violated, a description of the deficiency, and the facility's plan of correction.
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