F-F880
.
Level of Harm - Minimal harm or potential for actual harm
Residents Affected - Some
FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 35 of 35 235458
F-F880
.
Level of Harm - Minimal harm or potential for actual harm
Residents Affected - Some
FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 35 of 35 235458