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This document provides a summary of deficiencies identified during a survey of the Whispering Pines Nursing & Rehab Center, along with the provider\'s plan of correction for the noted deficiencies. It includes details of the complaint investigation, the allegations reviewed, and the outcomes of those investigations.
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How to fill out cms-2567
How to fill out cms-2567
01
Obtain a blank CMS-2567 form from the appropriate source, such as the CMS website or your local health department.
02
Begin by filling out the facility's information, including the name, address, and identification number.
03
State the purpose of the survey or inspection in the designated section.
04
Describe each deficiency found during the survey clearly and concisely, referencing the specific regulations involved.
05
Include any required evidence or documentation to support the findings of deficiencies.
06
List the corrective actions that the facility plans to implement to address each deficiency.
07
Review the completed form for accuracy and completeness before submission.
08
Submit the form to the appropriate CMS regional office by the deadline provided.
Who needs cms-2567?
01
CMS-2567 is needed by healthcare facilities that undergo surveys and inspections to ensure compliance with federal regulations.
02
It is also used by state survey agencies and CMS officials to document deficiencies in care and required corrective actions.
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What is cms-2567?
CMS-2567 is a form used by the Centers for Medicare & Medicaid Services (CMS) for reporting and documenting deficiencies in healthcare facilities.
Who is required to file cms-2567?
Healthcare facilities that receive funding from Medicare and Medicaid, and are subject to surveys and inspections, are required to file CMS-2567.
How to fill out cms-2567?
To fill out CMS-2567, facilities must list deficiencies noted during the survey, provide a plan of correction for each deficiency, and submit the completed form to CMS within the specified timeframe.
What is the purpose of cms-2567?
The purpose of CMS-2567 is to provide a formal documentation of violations and deficiencies found in healthcare facilities, ensuring compliance with federal regulations.
What information must be reported on cms-2567?
CMS-2567 must report the facility's name, address, deficiencies identified, applicable regulations, and the facility's plan of correction for each deficiency.
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