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
▼ 52D0398011 La Clinica De Los Campesinos, Inc 400 S Townline Rd Wautoma WI 12/27/2018 OJ4311 Standard
Deficiency Tag Deficiency Description Tag Type
D5407 PROCEDURE MANUAL Standard
D6019 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6053 TECHNICAL CONSULTANT RESPONSIBILITIES Standard
▼ 52D0398011 La Clinica De Los Campesinos, Inc 400 S Townline Rd Wautoma WI 07/19/2023 5S9811 Standard
Deficiency Tag Deficiency Description Tag Type
D2000 ENROLLMENT AND TESTING OF SAMPLES Condition
D3031 RETENTION REQUIREMENTS Standard
D5024 HEMATOLOGY Condition
D5203 SPECIMEN IDENTIFICATION AND INTEGRITY Standard
D5407 PROCEDURE MANUAL Standard
D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5421 ESTABLISHMENT AND VERIFICATION OF PERFORMANCE Standard
D5801 TEST REPORT Standard
D5813 TEST REPORT Standard
D6000 MODERATE COMPLEXITY LABORATORY DIRECTOR Condition
D6013 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6015 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6020 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6021 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6029 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6031 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6032 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6033 TECHNICAL CONSULTANT-MODERATE COMPLEXITY Condition
D6035 TECHNICAL CONSULTANT QUALIFICATIONS Standard
D6042 TECHNICAL CONSULTANT RESPONSIBILITIES Standard
D6046 TECHNICAL CONSULTANT RESPONSIBILITIES Standard
D6063 LABORATORY TESTING PERSONNEL Condition
D6065 TESTING PERSONNEL QUALIFICATIONS Standard
▼ 52D0398014 Thedacare Medical Center Wild Rose 601 Grove Ave Wild Rose WI 08/09/2018 137S11 Standard
Deficiency Tag Deficiency Description Tag Type
D2009 TESTING OF PROFICIENCY TESTING SAMPLES Standard
D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
▼ 52D0398014 Thedacare Medical Center Wild Rose 601 Grove Ave Wild Rose WI 11/04/2020 UHO111 Standard
Deficiency Tag Deficiency Description Tag Type
D5217 EVALUATION OF PROFICIENCY TESTING PERFORMANCE Standard
D5429 MAINTENANCE AND FUNCTION CHECKS Standard
D5437 CALIBRATION AND CALIBRATION VERIFICATION Standard
▼ 52D0398014 Thedacare Medical Center Wild Rose 601 Grove Ave Wild Rose WI 06/30/2022 FLBX11 Standard
Deficiency Tag Deficiency Description Tag Type
D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5429 MAINTENANCE AND FUNCTION CHECKS Standard
D6175 TESTING PERSONNEL RESPONSIBILITIES Standard
▼ 52D0398014 Thedacare Medical Center Wild Rose 601 Grove Ave Wild Rose WI 05/22/2024 UB5G11 Standard
Deficiency Tag Deficiency Description Tag Type
D5209 PERSONNEL COMPETENCY ASSESSMENT POLICIES Standard
D5411 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5415 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5431 MAINTENANCE AND FUNCTION CHECKS Standard
D5437 CALIBRATION AND CALIBRATION VERIFICATION Standard
D5439 CALIBRATION AND CALIBRATION VERIFICATION Standard
D5481 CONTROL PROCEDURES Standard
D5555 IMMUNOHEMATOLOGY Standard
D5781 CORRECTIVE ACTIONS Standard
D5801 TEST REPORT Standard
D6020 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6177 TESTING PERSONNEL RESPONSIBILITIES Standard
▼ 52D0661895 Kenosha County Div Of Health Laboratory 8600 Sheridan Rd Ste 600 Kenosha WI 06/25/2018 KXEC11 Standard
Deficiency Tag Deficiency Description Tag Type
D5401 PROCEDURE MANUAL Standard
▼ 52D0661895 Kenosha County Div Of Health Laboratory 8600 Sheridan Rd Ste 600 Kenosha WI 11/05/2020 L56K11 Standard
Deficiency Tag Deficiency Description Tag Type
D2009 TESTING OF PROFICIENCY TESTING SAMPLES Standard
D5411 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5785 CORRECTIVE ACTIONS Standard
D5805 TEST REPORT Standard
▼ 52D0661895 Kenosha County Div Of Health Laboratory 8600 Sheridan Rd Ste 600 Kenosha WI 07/12/2022 W81W11 Standard
Deficiency Tag Deficiency Description Tag Type
D2009 TESTING OF PROFICIENCY TESTING SAMPLES Standard
D6079 LABORATORY DIRECTOR RESPONSIBILITIES Standard
▼ 52D0661895 Kenosha County Div Of Health Laboratory 8600 Sheridan Rd Ste 600 Kenosha WI 07/25/2024 LN8P11 Standard
Deficiency Tag Deficiency Description Tag Type
D5415 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5441 CONTROL PROCEDURES Standard
D5449 CONTROL PROCEDURES Standard
D6013 LABORATORY DIRECTOR RESPONSIBILITIES Standard