S&C QCOR ASC 2567s
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ASCs 2567s
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Time Interval

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Provider Characteristics

Use these filters if you want to limit the report to providers that have certain characteristics. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

Survey Type & Deficiency Tags

Use these filters if you want to limit the reports to providers on specific survey types, or to reports that were cited for specific ASC deficiency tags and tag types. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

CCN and Facility Name

Use these filters if you know the name (or partial name) of the facility you are searching for, or the CMS Certification Number (CCN) for the facility you are searching for.

Other Survey Characteristics

Select one of the options below to filter by surveys that cite deficiencies or by surveys that are deficiency-free. By default, only surveys that cite deficiencies are displayed. Selecting "All" displays all surveys.

CMS Certification Number Facility Name Address City State CMS Region Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
▼ 52C0001034 Ambulatory Surgical Ctr Llc 2120 S Washburn St Oshkosh WI 5 (Chicago) 06/26/2019 JNPV11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0160 MEDICAL RECORDS Condition
Q0061 ANESTHETIC RISK AND EVALUATION Standard
Q0062 ANESTHETIC - DISCHARGE Standard
Q0104 SAFETY FROM FIRE Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0184 VERBAL ORDERS Standard
Q0233 SAFETY - ABUSE/HARASSMENT Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
▼ 52C0001034 Ambulatory Surgical Ctr Llc 2120 S Washburn St Oshkosh WI 5 (Chicago) 06/26/2019 JNPV21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0345 Fire Alarm System - Testing and Maintenance Standard
K0712 Fire Drills Standard
▼ 52C0001035 Froedtert Health West Bend Surgery Center 3212 Pleasant Valley Road West Bend WI 5 (Chicago) 07/19/2022 4F058-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0104 SAFETY FROM FIRE Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0266 DISCHARGE - ORDER Standard
▼ 52C0001035 Froedtert Health West Bend Surgery Center 3212 Pleasant Valley Road West Bend WI 5 (Chicago) 07/18/2022 4F058-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0232 Aisle, Corridor, or Ramp Width Standard
K0351 Sprinkler System - Installation Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 52C0001035 Froedtert Health West Bend Surgery Center 3212 Pleasant Valley Road West Bend WI 5 (Chicago) 07/23/2019 YB5111 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0062 ANESTHETIC - DISCHARGE Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0266 DISCHARGE - ORDER Standard
▼ 52C0001035 Froedtert Health West Bend Surgery Center 3212 Pleasant Valley Road West Bend WI 5 (Chicago) 07/23/2019 YB5121 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0353 Sprinkler System - Maintenance and Testing Standard
K0712 Fire Drills Standard
▼ 52C0001039 Wisconsin Laser And Surgery Center 10200 W Innovation Dr Suite 700 Milwaukee WI 5 (Chicago) 09/03/2025 1D594B-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0061 ANESTHETIC RISK AND EVALUATION Standard
Q0104 SAFETY FROM FIRE Standard
Q0181 ADMINISTRATION OF DRUGS Standard
Q0242 INFECTION CONTROL PROGRAM Standard
Q0262 ADMISSION AND PRE-SURGICAL ASSESSMENT Standard
▼ 52C0001039 Wisconsin Laser And Surgery Center 10200 W Innovation Dr Suite 700 Milwaukee WI 5 (Chicago) 09/03/2025 1D594B-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0291 Emergency Lighting Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 52C0001039 Wisconsin Laser And Surgery Center 10200 W Innovation Dr Suite 700 Milwaukee WI 5 (Chicago) 10/13/2021 75GQ11 Recertification
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0100 ENVIRONMENT Condition
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0241 SANITARY ENVIRONMENT Standard
▼ 52C0001039 Wisconsin Laser And Surgery Center 10200 W Innovation Dr Suite 700 Milwaukee WI 5 (Chicago) 10/13/2021 75GQ21 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0321 Hazardous Areas - Enclosure Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0919 Electrical Equipment - Other Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard