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Form CMS-804 Kitchen / Food Service Observation
What Is Form CMS-804?
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, 2016 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form CMS-804?
A: Form CMS-804 is a standardized form used to document observations of kitchen and food service practices in healthcare facilities.
Q: Who uses Form CMS-804?
A: Form CMS-804 is used by surveyors and inspectors from the Centers for Medicare & Medicaid Services (CMS) to assess compliance with food service regulations in healthcare facilities.
Q: What is the purpose of Form CMS-804?
A: The purpose of Form CMS-804 is to ensure that healthcare facilities are providing safe and sanitary food service to patients and residents.
Q: What does the form cover?
A: The form covers various aspects of food service, including food preparation, storage, handling, sanitation, and employee practices.
Q: How is Form CMS-804 used?
A: Surveyors and inspectors use Form CMS-804 to conduct on-site observations of kitchen and food service operations, documenting any deficiencies or areas of non-compliance.
Q: Are there any specific requirements for food service in healthcare facilities?
A: Yes, healthcare facilities are required to follow regulations outlined in the Code of Federal Regulations, specifically Title 42, Part 483, Subpart B - Requirements for Long TermCare Facilities.
Q: What happens if deficiencies are found on Form CMS-804?
A: If deficiencies are found, the healthcare facility may be required to implement corrective actions and demonstrate compliance during follow-up visits or surveys.
Q: Can healthcare facilities appeal the findings on Form CMS-804?
A: Yes, healthcare facilities have the right to appeal the findings and request a reconsideration or dispute the survey report.
Q: Is Form CMS-804 publicly available?
A: No, Form CMS-804 is not publicly available. It is only used by CMS surveyors and inspectors for official purposes.
Form Details:
- Released on June 1, 2016;
- 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 fillable version of Form CMS-804 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-804 Kitchen / Food Service Observation
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