S&C QCOR CLIA 2567s
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CLIA 2567s
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Time Interval

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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 CLIA 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).

CLIA ID and Facility Name

Use these filters if you know the name (or partial name) of 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 Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
▼ 04D0468990 Millard Henry Clinic 101 Skyline Dr Russellville AR 08/16/2019 PJ2T11 Standard
Deficiency Tag Deficiency Description Tag Type
D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5479 CONTROL PROCEDURES Standard
D5783 CORRECTIVE ACTIONS Standard
▼ 04D0468990 Millard Henry Clinic 101 Skyline Dr Russellville AR 03/16/2022 FGSS11 Standard
Deficiency Tag Deficiency Description Tag Type
D5791 ANALYTIC SYSTEMS QUALITY ASSESSMENT Standard
▼ 04D0468990 Millard Henry Clinic 101 Skyline Dr Russellville AR 08/21/2023 MFEJ11 Special
Deficiency Tag Deficiency Description Tag Type
D2016 SUCCESSFUL PARTICIPATION Condition
D2096 ROUTINE CHEMISTRY Standard
D6000 MODERATE COMPLEXITY LABORATORY DIRECTOR Condition
D6016 LABORATORY DIRECTOR RESPONSIBILITIES Standard
▼ 04D0468992 Pathology Services Laboratory Pa 1430 West C Street Russellville AR 05/24/2023 KX4T11 Standard
Deficiency Tag Deficiency Description Tag Type
D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
▼ 04D0469021 Millard Henry Clinic 1601 North Church Atkins AR 06/26/2018 1B8X11 Standard
Deficiency Tag Deficiency Description Tag Type
D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D6005 LABORATORY DIRECTOR RESPONSIBILITIES Standard
▼ 04D0469031 Clarksville Medical Group, Pa 601 W Mckennon St Clarksville AR 05/21/2019 DQ7X11 Standard
Deficiency Tag Deficiency Description Tag Type
D6032 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6046 TECHNICAL CONSULTANT RESPONSIBILITIES Standard
▼ 04D0469031 Clarksville Medical Group, Pa 601 W Mckennon St Clarksville AR 11/24/2021 UVG711 Standard
Deficiency Tag Deficiency Description Tag Type
D5291 GENERAL LABORATORY SYSTEMS QUALITY ASSESSMENT Standard
D5311 SPECIMEN SUBMISSION, HANDLING, AND REFERRAL Standard
D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5481 CONTROL PROCEDURES Standard
D6032 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6053 TECHNICAL CONSULTANT RESPONSIBILITIES Standard
▼ 04D0469031 Clarksville Medical Group, Pa 601 W Mckennon St Clarksville AR 11/16/2023 JU1D11 Standard
Deficiency Tag Deficiency Description Tag Type
D5407 PROCEDURE MANUAL Standard
D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
▼ 04D0469031 Clarksville Medical Group, Pa 601 W Mckennon St Clarksville AR 09/11/2025 12QX11 Standard
Deficiency Tag Deficiency Description Tag Type
D5403 PROCEDURE MANUAL Standard
D5481 CONTROL PROCEDURES Standard
D5791 ANALYTIC SYSTEMS QUALITY ASSESSMENT Standard
▼ 04D0469039 Johnson Regional Medical Center 1100 East Poplar Clarksville AR 09/28/2018 EL0N11 Standard
Deficiency Tag Deficiency Description Tag Type
D0000 Initial Comments - Not A Deficiency Citation Memo
D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5415 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5783 CORRECTIVE ACTIONS Standard
D6046 TECHNICAL CONSULTANT RESPONSIBILITIES Standard
D6107 LABORATORY DIRECTOR RESPONSIBILITIES Standard