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This version of the form is not currently in use and is provided for reference only. Download this version of
Form CMS-2567
for the current year.
Form CMS-2567 Statement of Deficiencies and Plan of Correction
What Is Form CMS-2567?
This is a legal form that was released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services on June 1, 2021 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is a Form CMS-2567?
A: Form CMS-2567 is a Statement of Deficiencies and Plan of Correction.
Q: What is the purpose of Form CMS-2567?
A: The purpose of Form CMS-2567 is to document and report any deficiencies found during a survey of a healthcare facility.
Q: Who uses Form CMS-2567?
A: Form CMS-2567 is used by surveyors from the Centers for Medicare and Medicaid Services (CMS) to document deficiencies.
Q: What is a deficiency?
A: A deficiency is a violation or failure to meet the requirements of federal health and safety regulations.
Q: What is a Plan of Correction?
A: A Plan of Correction is a document that outlines the actions a facility will take to correct deficiencies and prevent their recurrence.
Q: Is the Form CMS-2567 publicly available?
A: Yes, the Form CMS-2567 and its associated information are considered public records.
Q: Can the public access the Form CMS-2567?
A: Yes, the public can request access to the Form CMS-2567 through the Freedom of Information Act (FOIA).
Form Details:
- Released on June 1, 2021;
- The latest available edition released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form CMS-2567 by clicking the link below or browse more documents and templates provided by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services.
Download Form CMS-2567 Statement of Deficiencies and Plan of Correction
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