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This document by the Department of Health and Human Services outlines the findings from a survey conducted on January 16, 2024, at St. Charles Health Campus concerning complaint IN00425513. The facility was found to be in compliance with applicable regulations, with no deficiencies cited related to the complaint. It includes details on facility identification, survey completion date, and regulatory compliance.
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How to fill out cms-2567
How to fill out cms-2567
01
Gather necessary information about the facility, including its name, address, and contact details.
02
Determine the type of survey being reported (e.g., standard, complaint).
03
Use the provided sections to document findings, each focusing on specific regulatory requirements.
04
Clearly state the deficiencies identified during the survey in the appropriate sections.
05
Provide detailed descriptions and evidence for each deficiency, including who was interviewed and what observations were made.
06
Include corrective action plans if applicable.
07
Review the completed form for accuracy before submission.
Who needs cms-2567?
01
Nursing facilities that are inspected or surveyed by the Centers for Medicare & Medicaid Services (CMS).
02
Facilities seeking to address deficiencies noted during a survey.
03
State agencies that must document compliance with federal regulations.
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What is cms-2567?
CMS-2567 is a form used by healthcare facilities to report deficiencies identified during surveys conducted by the Centers for Medicare & Medicaid Services (CMS) or by state survey agencies.
Who is required to file cms-2567?
Healthcare facilities that receive funding from Medicare and Medicaid programs are required to file CMS-2567 when deficiencies are identified.
How to fill out cms-2567?
To fill out CMS-2567, facilities must provide detailed information about the deficiencies, including the nature and severity of each issue and the corrective actions taken or planned to address them.
What is the purpose of cms-2567?
The purpose of CMS-2567 is to ensure that healthcare facilities address deficiencies in compliance with federal standards and to protect the quality of care provided to patients.
What information must be reported on cms-2567?
CMS-2567 must report the specific deficiencies noted in the survey, including the locations, nature of the deficiencies, and the plan for correction.
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