CMS-2567
Definition: The official Statement of Deficiencies and Plan of Correction form used to document survey findings. The left side contains surveyor-cited deficiencies, and the right side is reserved for the facility's Plan of Correction response.
In Practice
The CMS-2567 is the formal document that triggers the Plan of Correction process. Facilities receive this document after a survey and must respond within 10 calendar days. It includes the F-Tag number, scope and severity rating, and detailed observations for each deficiency. The completed document becomes a public record.