| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 883831 | (X3) Date Survey Completed 09/28/2020 |
| Name of Provider or Supplier Spring City Family Clinic Pllc | Street Address, City, State 126 Lavender Street Ste 2, Spring City, 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) |
| J0150 | PATIENT HEALTH RECORDS 491.10 Patient health records This CONDITION is not met as evidenced by: Based on clinic documentation review and interview the clinic failed to have current clinic patient health records policies. The findings include: Review of a policy and procedure book last dated 2018 provided by the Office Manger, revealed the policy and procedure book was for another RHC facility and not for Spring City Family Medical Clinic Pllc. Further review revealed the clinic did not have patient health record policies. Interview with the clinic consultant on 9/28/2020 at 1:05 PM., by phone, confirmed the clinic failed to develop and establish patient health records policies. |