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

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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
▼ 52D0397019 Burnett Medical Center 257 W St George Ave Grantsburg WI 12/02/2020 NMML11 Standard
Deficiency Tag Deficiency Description Tag Type
D5217 EVALUATION OF PROFICIENCY TESTING PERFORMANCE Standard
D5449 CONTROL PROCEDURES Standard
D5785 CORRECTIVE ACTIONS Standard
D6085 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6093 LABORATORY DIRECTOR RESPONSIBILITIES Standard
▼ 52D0397019 Burnett Medical Center 257 W St George Ave Grantsburg WI 09/08/2022 TK2Y11 Standard
Deficiency Tag Deficiency Description Tag Type
D5421 ESTABLISHMENT AND VERIFICATION OF PERFORMANCE Standard
D5545 HEMATOLOGY Standard
▼ 52D0397019 Burnett Medical Center 257 W St George Ave Grantsburg WI 07/18/2024 DVXS11 Standard
Deficiency Tag Deficiency Description Tag Type
D5209 PERSONNEL COMPETENCY ASSESSMENT POLICIES Standard
D5403 PROCEDURE MANUAL Standard
D5421 ESTABLISHMENT AND VERIFICATION OF PERFORMANCE Standard
D5437 CALIBRATION AND CALIBRATION VERIFICATION Standard
D5477 CONTROL PROCEDURES Standard
▼ 52D0397019 Burnett Medical Center 257 W St George Ave Grantsburg WI 11/24/2025 YAUE11 Special
Deficiency Tag Deficiency Description Tag Type
D0000 Initial Comments - Not A Deficiency Citation Memo
D2016 SUCCESSFUL PARTICIPATION Condition
D2097 ROUTINE CHEMISTRY Standard
D6000 MODERATE COMPLEXITY LABORATORY DIRECTOR Condition
D6004 LABORATORY DIRECTOR RESPONSIBILITIES Standard
▼ 52D0397042 Northlakes Community Clinic 15954 Rivers Edge Dr Hayward WI 11/07/2018 N8O211 Standard
Deficiency Tag Deficiency Description Tag Type
D5409 PROCEDURE MANUAL Standard
D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5421 ESTABLISHMENT AND VERIFICATION OF PERFORMANCE Standard
D5805 TEST REPORT Standard
D6026 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6031 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6063 LABORATORY TESTING PERSONNEL Condition
D6065 TESTING PERSONNEL QUALIFICATIONS Standard
▼ 52D0397042 Northlakes Community Clinic 15954 Rivers Edge Dr Hayward WI 12/03/2020 ECUF11 Standard
Deficiency Tag Deficiency Description Tag Type
D6033 TECHNICAL CONSULTANT-MODERATE COMPLEXITY Condition
D6035 TECHNICAL CONSULTANT QUALIFICATIONS Standard
D6046 TECHNICAL CONSULTANT RESPONSIBILITIES Standard
▼ 52D0397042 Northlakes Community Clinic 15954 Rivers Edge Dr Hayward WI 11/15/2022 XVLI11 Standard
Deficiency Tag Deficiency Description Tag Type
D5805 TEST REPORT Standard
▼ 52D0397042 Northlakes Community Clinic 15954 Rivers Edge Dr Hayward WI 08/14/2024 S5WI11 Standard
Deficiency Tag Deficiency Description Tag Type
D5421 ESTABLISHMENT AND VERIFICATION OF PERFORMANCE Standard
▼ 52D0397081 Northlakes Community Clinic 600 Shell Creek Rd Minong WI 11/07/2018 Z70811 Standard
Deficiency Tag Deficiency Description Tag Type
D5409 PROCEDURE MANUAL Standard
D5805 TEST REPORT Standard
D6063 LABORATORY TESTING PERSONNEL Condition
D6065 TESTING PERSONNEL QUALIFICATIONS Standard
▼ 52D0397081 Northlakes Community Clinic 600 Shell Creek Rd Minong WI 12/03/2020 ZWB011 Standard
Deficiency Tag Deficiency Description Tag Type
D6033 TECHNICAL CONSULTANT-MODERATE COMPLEXITY Condition
D6035 TECHNICAL CONSULTANT QUALIFICATIONS Standard