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This document is a report by the Centers for Medicare & Medicaid Services detailing the findings of a survey conducted on October 29, 2024, at Owen Valley Rehabilitation and Healthcare Center. It includes a summary of deficiencies, the provider\'s plan of correction, and compliance information related to the investigation of complaint IN00445209.
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How to fill out cms-2567
How to fill out cms-2567
01
Obtain the CMS-2567 form from the appropriate CMS website or your local CMS office.
02
Begin by filling out the facility's information, including name, address, and provider number.
03
Provide the date of the survey as well as the state and federal tags associated with the deficiencies.
04
List each deficiency in detail, referencing the specific regulations that were violated.
05
Include a plan of correction for each deficiency, outlining steps to resolve the issues.
06
Sign and date the form to certify that the information is true and complete.
07
Submit the completed CMS-2567 to the relevant CMS regional office for review.
Who needs cms-2567?
01
The CMS-2567 is needed by healthcare facilities that have undergone a survey by CMS to document deficiencies.
02
It is required by providers who need to illustrate compliance with regulatory standards.
03
State survey agencies may also need it for monitoring and enforcement purposes.
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What is cms-2567?
CMS-2567 is a form used by facilities to report compliance with Medicare and Medicaid regulations and to convey the status of their performance and adherence to safety and quality standards.
Who is required to file cms-2567?
Health care facilities that participate in Medicare and Medicaid programs are required to file CMS-2567.
How to fill out cms-2567?
To fill out CMS-2567, facilities must provide detailed information about compliance with standards by completing each section of the form accurately, including survey results and corrective actions taken.
What information must be reported on cms-2567?
CMS-2567 requires reporting information such as facility characteristics, survey findings, areas of non-compliance, and corrective action plans.
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