Get Statement Of Deficiencies Citation Summary Sheet Printed: 10/11/2011 For: Burlington County

Filling out the Statement of Deficiencies Citation Summary Sheet is a crucial process for maintaining compliance within health care facilities. This guide provides step-by-step instructions on how to accurately complete the form, ensuring that all necessary information is included and correctly formatted.

Follow the steps to complete the form efficiently.

1. Begin by selecting the ‘Get Form’ button to access the document and open it in your preferred editor.
2. Fill in the provider or supplier identification number in the designated field. This number is crucial for referencing the specific facility associated with the deficiencies.
3. Enter the date of the survey at the specified location in the form. This helps to document when the assessment took place and is essential for the processing of findings.
4. In the street address section, accurately input the full address, including city, state, and zip code of the facility. Ensure all entries are correct to avoid any processing issues.
5. For each deficiency listed, provide the regulation ID, version, building number, tag number, and tag title. Make sure that this information corresponds to the findings of the surveys conducted.
6. Detail each deficiency in the 'summary statement of deficiencies' section. Include all regulatory or life safety code identifying information needed for clarity.
7. Document the provider's plan of correction next to each deficiency. This section should clearly outline the steps that will be taken to address the issues cited during the survey.
8. Conclude by signing and dating the form in the appropriate sections. This confirms that the information provided is accurate and that you are in agreement with the corrections proposed.
9. Once completed, save the changes made to the document. The completed form can now be downloaded, printed, or shared as necessary.

Complete your documents online efficiently and correctly to ensure compliance with health standards.