Get Printed: 10/07/2014 Form Approved Omb No. 0938 0391 - Doh Sd

Filling out the PRINTED: 10/07/2014 FORM APPROVED OMB NO. 0938 0391 - Doh Sd online can be a straightforward process if you follow the right steps. This guide aims to assist you in providing accurate information and completing the form effectively.

Follow the steps to fill out the form accurately online.

1. Click the ‘Get Form’ button to access the form and display it in the online editor.
2. Enter the provider or supplier identification number in section (X1). This unique number identifies your facility.
3. Complete section (X2) if applicable, indicating any multiple construction aspects—this pertains to the building or the wings of your facility.
4. In section (X3), input the date the survey was completed to establish a timeline for your records.
5. Fill out the name, street address, city, state, and ZIP code of your provider or supplier as indicated in the relevant sections. Ensure all information is accurate.
6. Address each deficiency in the summary statement section, ensuring each is connected to the relevant regulatory or Life Safety Code (LSC) by providing full identifying information.
7. Ascertain the provider's plan of correction, making sure each corrective action corresponds to the applicable deficiency outlined in your summary.
8. At the end of the form, ensure the signature of the laboratory director or provider/supplier representative is included, along with their title.
9. Finally, enter the completion date in section (X5) and today’s date in section (X6). Review the form for any errors.
10. After completing the form, you can choose to save changes, download, print, or share the completed document as needed.

Complete your documents online with confidence and clarity.