Get Printed: 10/16/2011 Statement Of Deficiencies Citation Summary Sheet For: Middlesex Surgery Center

This guide provides comprehensive instructions for completing the printed Statement of Deficiencies Citation Summary Sheet for Middlesex Surgery Center online. Follow these steps to ensure accurate and efficient completion of the form.

Follow the steps to accurately fill out the citation summary sheet.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by entering the provider identification number in the designated field, which is 24031 for Middlesex Surgery Center.
3. Input the name of the provider or supplier, which is Middlesex Surgery Center, in the appropriate section.
4. Note the date of the survey completion, which is 01/14/2011. This should be placed in the specified field.
5. Fill in the street address, city, state, and ZIP code. For this form, it is 1921 Oak Tree Road, Edison, NJ 08820.
6. List the citations from the survey by including the regulation type, regulation ID, regulation version, building number, tag number, and tag title for each deficiency noted.
7. Provide a summary statement for each deficiency, preceded by the full regulatory or Life Safety Code identifying information.
8. Complete the provider's plan of correction by detailing corrective actions for each deficiency, ensuring that they correspond to the appropriate deficiency tags.
9. Finally, review the completed form for accuracy and completeness. You can then save, download, print, or share the completed summary sheet if necessary.

Complete your assessment forms online today to ensure compliance and effective management of deficiencies.