Pb 22 form 2025

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The document is a Facility Report Form used by the Department of Health and the Division of Nursing Care Facilities to investigate allegations of abuse, neglect, or misappropriation of property involving nurse aides or other facility employees. It includes sections for general information about the facility and incident, details about the alleged perpetrator and victim, descriptions of the incident, investigative activities, findings, conclusions, actions taken, and relevant documentation. The form is designed to ensure compliance with Act 13 reporting requirements.

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