Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391

Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 010001 (X3) Date Survey Completed 09/29/2017
Name of Provider or Supplier Southeast Health Medical Center Street Address, City, State 1108 Ross Clark Circle, Dothan, AL
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
A0000 A full survey following a complaint with conditions of participation cited was completed at the request of The Centers for Medicare and Medicaid Services (CMS) on 9/29/17. Based on the full survey the Alabama State Survey Agency recommends Southeast Alabama Medical Center be found out of compliance with the condition 482.41: Physical Environment, based on the Life Safety Code survey findings. The cited conditions from the 8/24/17 complaint survey were in substantial compliance based on the acceptable plan of correction and on-site full survey: 482.12, Governing Body; 482.13, Patient Rights; 482.21, Quality Assurance Performance Improvement and 482.23, Nursing Services.