| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 883842 | (X3) Date Survey Completed 05/11/2026 |
| Name of Provider or Supplier Dickson Medical Associate White Bluff | Street Address, City, State 2004 Highway 47 N, White Bluff, 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) |
| E0000 | An unannounced on-site survey for Emergency Preparedness was initiated during a Rural Health Center recertification survey on 05/11/2026 at 9:30 AM. An on-site Entrance Conference was held with the facility Administrator on 05/11/2026 at 10:30 AM. The purpose and scope of the survey were explained. Requests were made and an opportunity for questions/concerns were provided. An Exit Conference was held with the facility Administrator at the facility on 05/11/2026 at 1:30 PM. The Administrator was informed of preliminary findings of deficiencies during the survey for Emergency Preparedness.The facility was cited Condition Level deficiencies in the Conditions of Coverage for the Emergency Preparedness for Rural Health Clinics. The final survey findings to be provided to the facility via Form 2567. |