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 013401 (X3) Date Survey Completed 03/01/2023
Name of Provider or Supplier Lawrence Rural Health Clinic-Courtland Street Address, City, State 350 Tennessee Street P O Box 320, Courtland, 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)
J0124 PROVISION OF SERVICES

491.9(b) Patient care policies. (3) The policies include: (i) A description of the services the clinic . . . furnishes directly and those furnished through agreement or arrangement. (ii) Guidelines for the medical management of health problems which include the conditions requiring medical consultation and/or patient referral, the maintenance of health care records, and procedures for the periodic review and evaluation of the services furnished by the clinic . . .


This STANDARD is not met as evidenced by:
Based on review of the clinic policy and procedure manual and interview, it was determined the clinic's written policies and procedures failed to include a policy for medical management guidelines of frequently encountered health conditions, the actions non-physician practitioners/NP (Nurse Practitioner) were permitted to initiate and implement, and circumstances that require consultation and referral. This had the potential to negatively affect all patients treated at the clinic. Findings include: 1. On 3/1/23 at 2:06 PM, the surveyor reviewed the clinic's policies and procedures and requested to review the clinic's policy for medical management guidelines for frequently encountered health conditions treated at the clinic. On 3/1/23 at 2:06 PM, Employee Identifier (EI) # 1, Practice Manager Rural Health Clinics, confirmed there was no written policy that included medical management guidelines/protocols for the nurse practitioners.