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This document outlines the deficiencies identified during the investigation of complaint #IN00394738 at In-Pact Inc, a group home located in Merrillville, IN. It includes details on incidents of neglect
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How to fill out cms-2567
How to fill out cms-2567
01
Review the instructions provided with the CMS-2567 form.
02
Start with the facility name and address at the top of the form.
03
Enter the date of the survey or investigation.
04
Identify the type of survey (initial, revisit, etc.) in the designated section.
05
Document the scope and severity of deficiencies in the appropriate areas.
06
Include detailed descriptions of each deficiency found during the survey.
07
Provide any citations that support your findings from regulations.
08
Sign and date the form upon completion.
Who needs cms-2567?
01
Healthcare facilities undergoing a survey or inspection.
02
Providers submitting information regarding compliance deficiencies.
03
State survey agencies conducting evaluations of healthcare services.
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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 and Medicaid Services (CMS) or state survey agencies.
Who is required to file cms-2567?
Healthcare facilities that are certified by CMS, including nursing homes, hospitals, and home health agencies, are required to file CMS-2567 to report any identified deficiencies.
How to fill out cms-2567?
To fill out CMS-2567, facilities must accurately document the deficiencies found during surveys, including specific details such as the nature of the deficiency, the area affected, and the actions taken to address the issues.
What is the purpose of cms-2567?
The purpose of CMS-2567 is to provide a formal record of deficiencies found in healthcare facilities that need to be addressed for compliance with federal regulations.
What information must be reported on cms-2567?
CMS-2567 must report information including the facility identification, identification number of the deficiencies, the specific regulation violated, the date of the survey, and any corrective actions taken or planned.
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