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This document summarizes the findings from a survey conducted at Waters of Columbia City Skilled Nursing Facility on October 1, 2024, regarding complaints IN00443476 and IN00443957. It indicates that the facility is in compliance with relevant health regulations and outlines the facility details including provider information and census data.
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How to fill out cms-2567
How to fill out cms-2567
01
Gather necessary information about the facility being surveyed.
02
Review the survey findings and any deficiencies noted.
03
Open the CMS-2567 form and start with the identification section at the top.
04
Fill in the facility's name, address, and other identifying information.
05
List the deficiencies identified during the survey, using clear and concise language.
06
Specify the regulation or requirement that was not met for each deficiency.
07
Include a related plan of correction for each deficiency, if applicable.
08
Review the form for accuracy and completeness before submission.
09
Submit the completed CMS-2567 to the appropriate CMS regional office.
Who needs cms-2567?
01
Health care facilities undergoing surveys or inspections.
02
Providers that need to document compliance with CMS regulations.
03
Organizations that require formal notice of deficiencies.
04
Facilities preparing plans of correction for identified issues.
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What is cms-2567?
CMS-2567 is a form used by healthcare providers to report compliance with certain health and safety standards, particularly in long-term care facilities.
Who is required to file cms-2567?
Healthcare providers, particularly those in long-term care facilities, are required to file CMS-2567 to document compliance with federal regulations.
How to fill out cms-2567?
To fill out CMS-2567, a provider must complete the sections of the form detailing findings from surveys, describe deficiencies, and outline plans for correction.
What is the purpose of cms-2567?
The purpose of CMS-2567 is to ensure that healthcare facilities adhere to safety and quality standards through the documentation of compliance and deficiencies.
What information must be reported on cms-2567?
CMS-2567 must report information including regulatory citations, a description of deficiencies, and the facility's plan of correction.
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