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This document outlines the deficiencies found during a compliance survey at Hickory Creek at Winamac, along with the provider\'s plan of correction to address them. It includes identifying numbers, survey completion dates, and compliance information regarding state licensure and federal regulations.
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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 from the appropriate regulatory authority.
02
Read the instructions provided with the form carefully.
03
Begin filling out the provider's information at the top of the form, including name, address, and contact details.
04
Identify the type of facility or provider and enter the corresponding information.
05
List the survey date and the date the report is being completed.
06
Detail the deficiencies found during the survey, using specific citations that correspond to the regulations.
07
Provide a Plan of Correction for each deficiency listed, describing how the facility plans to address the issues.
08
Ensure that all information is accurate and complete before submission.
09
Sign and date the form at the bottom, confirming the accuracy of the provided information.
Who needs cms-2567?
01
Healthcare facilities that are subject to Medicare and Medicaid compliance requirements.
02
State survey agencies conducting inspections of healthcare providers.
03
Providers seeking to address deficiencies noted during inspections.
04
Healthcare organizations looking to improve their compliance standing.
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What is cms-2567?
CMS-2567 is a form used by healthcare facilities to report deficiencies and violations of health and safety standards.
Who is required to file cms-2567?
Healthcare facilities that are certified by Medicare or Medicaid and are inspected by the Centers for Medicare & Medicaid Services (CMS) are required to file CMS-2567.
How to fill out cms-2567?
To fill out CMS-2567, facilities must enter specific information about their deficiencies, including the dates of the inspection, a description of the violation, and corrective actions taken.
What is the purpose of cms-2567?
The purpose of CMS-2567 is to document non-compliance with federal health and safety regulations, facilitating the correction of issues and promoting quality care.
What information must be reported on cms-2567?
CMS-2567 requires reporting of facility identification details, deficiency findings, dates of incidents, and corrective action plans.
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