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 883828 (X3) Date Survey Completed 11/25/2025
Name of Provider or Supplier Anew Family Medical Pllc Street Address, City, State 111 Front Street, Henderson, TN
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)
J0125 PROVISION OF SERVICES

491.9(b) Patient care policies. (3) The policies include: (iii) Rules for the storage, handling, and administration of drugs and biologicals.


This STANDARD is not met as evidenced by:
Based on observations and interview, the Rural Health Clinic (RHC) failed to maintain drugs according to standards set by the manufacturer, as a drug or biological is outdated after its expiration date. The findings included: 1. Observations on 9/23/2025 at 2:00 PM revealed the following medications were found in the unlocked emergency box: Nitro-spray (used for chest pain) - expired 6/20/2024; Nitrotab (used for chest pain)- expired 2024; Epi- pen (used for allergic reaction)- expired 2/2023; Glucose (treat low blood sugar)- expired 8/2025; Bayer aspirin (used to slow blood from clotting)- expired 4/2024; Diazepam (treats anxiety)- expired 1/2023. 2. During an interview on 9/23/2025 at 2:00PM, the Office Manager verified that the medications were expired and should be removed from the emergency box.