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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/CLIAAND PLAN OF CORRECTIONIDENTIFICATION NUMBER:15512105/20/2016FORM

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Begin by reading the survey instructions carefully.

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Locate the date section on the survey, typically found at the top of the first page.

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Enter the date using the format MMDDYY, which means you write '051016' as May 10, 2016.

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Survey date 051016 refers to a specific date when a survey was conducted, often used in data collection and reporting.

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