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This document outlines the deficiencies identified during the compliance survey of Waters of Peru Skilled Nursing Facility and includes the provider\'s plan of correction in response to these deficiencies. The survey evaluates compliance with federal and state regulations for skilled nursing facilities.
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How to fill out cms-2567
How to fill out cms-2567
01
Begin by entering the name and address of the facility at the top of the form.
02
Provide the date of the survey and the surveyor's name.
03
List the deficiencies observed during the survey in the appropriate sections.
04
Use clear and concise language to describe each deficiency.
05
Include references to specific regulations or standards that were violated.
06
Indicate the severity of each deficiency (e.g., immediate jeopardy, harm, etc.).
07
Document any plans of correction provided by the facility.
08
Review the completed form for accuracy before submission.
Who needs cms-2567?
01
CMS-2567 is required by healthcare facilities that are subject to Medicare and Medicaid regulations for reporting deficiencies found during inspections.
02
The form is primarily used by state survey agencies, compliance officers, and healthcare providers.
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What is cms-2567?
CMS-2567 is a form used by facilities to report compliance with the Medicare and Medicaid programs, specifically to communicate findings and action plans for addressing deficiencies identified during surveys.
Who is required to file cms-2567?
Facilities that participate in Medicare and Medicaid programs are required to file CMS-2567 when they receive a notice of deficiencies during a survey.
How to fill out cms-2567?
To fill out CMS-2567, facilities must accurately report the deficiencies identified, describe the steps taken to correct these issues, and provide a plan of correction along with supporting documentation.
What is the purpose of cms-2567?
The purpose of CMS-2567 is to document facility compliance with health and safety standards, and ensure that corrective actions are implemented to resolve any identified deficiencies.
What information must be reported on cms-2567?
CMS-2567 must report the nature of the deficiencies, the facility's plan of correction, and the timelines for implementation of corrective actions.
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