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DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop C22116 Baltimore, Maryland 212441850 Office of Clinical Standards & Quality/Survey
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Healthcare professionals: This document may be needed by healthcare professionals who are responsible for conducting patient safety quality care surveys in hospitals or healthcare facilities. It provides a standardized template for collecting and analyzing data related to patient safety and quality care.
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This document is a survey worksheet related to patient safety and quality care in hospitals.
Hospitals and healthcare facilities are required to file this document.
The document should be filled out with accurate information regarding patient safety and quality care measures.
The purpose of this document is to assess and improve patient safety and quality care in hospitals.
Information related to various patient safety and quality care measures must be reported on this document.
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