Statement of Deficiencies and Plan of Correction (CMS-2567)

This Paperwork package provides information regarding the form used by the Medicare, Medicaid, and the Clinical Laboratory Improvement Amendments (CLIA) programs to document a health care facility's compliance or noncompliance (deficiencies) with regard to the Medicare/Medicaid Conditions of Participation and Coverage, the requirements for participation for Skilled Nursing Facilities and Nursing Facilities, and for certification under CLIA. This form becomes the evidentiary basis for CMS certification decisions (including termination or denial of participation), and the form of public disclosure.

The latest form for Statement of Deficiencies and Plan of Correction (CMS-2567) expires 2023-05-31 and is listed under ICR 201912-0938-007.