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 013424 (X3) Date Survey Completed 01/05/2018
Name of Provider or Supplier Regional Medical Center Clinics Street Address, City, State 125 Church Street, Georgiana, 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)
J0023 MAINTENANCE
CFR(s): 491.6(b)(2)

Drugs and biologicals are appropriately stored; and


This STANDARD is not met as evidenced by:
No deficiency details available.
J0070 RECORDS SYSTEM
CFR(s): 491.10(a)(3)

For each patient receiving health care services, the clinic ... maintains a record that includes, as applicable: (i) Identification and social data, evidence of consent forms, pertinent medical history, assessment of the health status and health care needs of the patient, and a brief summary of the episode, disposition, and instructions to the patient; (ii) Reports of physical examinations, diagnostic and laboratory test results, and consultative findings; (iii) All physician's orders, reports of treatments and medications and other pertinent information necessary to monitor the patient's progress; (iv) Signatures of the physician or other health care professional.


This STANDARD is not met as evidenced by:
No deficiency details available.