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)
J0162 PROGRAM EVALUATION

491.11(d) The clinic or center staff considers the findings of the evaluation and takes corrective action if necessary.


This STANDARD is not met as evidenced by:
Based on review of the Rural Health Clinic (RHC)'s Policy and Procedures, Evidence manuals and interview, the rural health clinic (RHC) failed to consider the findings of evaluations and take corrective action as needed. The findings included: Review of the Rural Health Clinic (RHC)'s Policy and Procedures, Evidence manuals and interview revealed there was no documentation of findings of evaluations and needed corrective actions. During an interview on 9/23/2025, at 1:00 PM, during the onsite survey, the Office Manager verified the RHC did not have documentation of a bi-annual program evaluation being completed that considered the findings and recommendations for change, if any, taken corrective actions as necessary, such as changes in policies or, with respect to clinical personnel, provision of additional training, changes in level of supervision, or even limiting or terminating clinical privileges.