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This document provides a summary of deficiencies identified during a survey of the Heritage Park facility dated January 8, 2024. The facility was found to be in compliance regarding the investigation of Complaint IN00424241, with no deficiencies cited. The document includes identification numbers, facility information, and compliance standards.
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How to fill out cms-2567
How to fill out cms-2567
01
Obtain the CMS-2567 form from the CMS website or your state health department.
02
Enter the facility name, address, and CMS certification number at the top of the form.
03
Fill in the date of the survey and the surveyor's name.
04
List any deficiencies found during the inspection in the designated section.
05
Provide a detailed explanation for each deficiency, including the relevant regulation and the area of non-compliance.
06
Include any corrective actions that have been taken or are planned to address the deficiencies.
07
Review the completed form for accuracy and completeness.
08
Sign and date the form before submitting it to the appropriate CMS regional office.
Who needs cms-2567?
01
Health care facilities that participate in Medicare or Medicaid programs.
02
Organizations conducting surveys of health care facilities.
03
State survey agencies and accrediting bodies.
04
Facilities seeking to demonstrate compliance with federal regulations.
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What is cms-2567?
CMS-2567 is a form used by healthcare providers to report deficiencies identified during surveys conducted by the Centers for Medicare & Medicaid Services (CMS).
Who is required to file cms-2567?
Healthcare facilities and providers that participate in 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, providers must accurately document the deficiencies observed during the survey, providing specific details about each violation and corrective actions taken.
What is the purpose of cms-2567?
The purpose of CMS-2567 is to inform healthcare providers of deficiencies in compliance with federal regulations and to establish a plan for correction.
What information must be reported on cms-2567?
CMS-2567 requires reporting detailed descriptions of violations, the regulatory citations related to each deficiency, and corrective actions taken or planned by the provider.
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