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)
J0135 PROVISION OF SERVICES

491.9(a) Basic requirements: (3) The laboratory requirements in paragraph (c)(2) of this section apply to RHCs, . . . 491.9(c) Direct services (2) Laboratory. These requirements apply to RHCs . . . . The RHC provides laboratory services in accordance with part 493 of this chapter, which implements the provisions of section 353 of the Public Health Service Act. The RHC provides basic laboratory services essential to the immediate diagnosis and treatment of the patient, including: (i) Chemical examinations of urine by stick or tablet method or both (including urine ketones); (ii) Hemoglobin or hematocrit; (iii) Blood glucose; (iv) Examination of stool specimens for occult blood; (v) Pregnancy tests; and (vi) Primary culturing for transmittal to a certified laboratory.


This STANDARD is not met as evidenced by:
Based on observation, clinic policy, and interview with staff, it was determined the clinic failed to provide laboratory services to include on-site hematocrit and/or hemaglobin testing. This had the potential to affect all patients served by the clinic. Findings include: Clinic Policy: Lawrence Rural Health Clinics Policy Number: None Review Date: 11/2022 Provision of Services: ...G. Laboratory and X-Ray Services 1. The ability to perform on-site basic laboratory services including hematocrit,...will be facilitated by the clinic staff.... 1. A tour of the clinic was conducted on 2/28/23 at 9:15 AM which included the clinic's laboratory (lab) station. During the tour, no equipment or supplies were observed to be able to perform hematocrit and/or hemaglobin testing as required on-site. Employee Identifier (EI) # 2, Clinical Coordinator, was present during the tour of the lab. The surveyor asked EI # 2 if the clinic performed hematocrit or hemaglobin testing on-site? EI # 2 stated there was no equipment available to perform hematocrit or hemaglobin testing. The clinic failed to provide all on-site lab tests as required for a rural health clinic, including hematocrit and/or hemaglobin. EI # 2 confirmed at 10:10 AM on 2/28/23 the clinic did not perform hematocrit or hemoglobin testing on-site.