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 883844 (X3) Date Survey Completed 04/01/2026
Name of Provider or Supplier Wtpc, Llc Street Address, City, State 541 West Park. Place, 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)
J0100 STAFFING AND STAFF RESPONSIBILITIES

491.8(b) Physician responsibilities. The physician performs the following: (1) . . . provides medical direction for the clinic's . . . health care activities and consultation for, and medical supervision of, the health care staff. (3) . . . provides medical orders, and provides medical care services to the patients of the clinic or center.


This STANDARD is not met as evidenced by:
Based on interview, the Rural Health Clinic (RHC) failed to ensure that the physician provided collaboration and supervision for the non-physician practitioner. The findings included: During an interview on 4/1/2026 at 12:45 PM, the Practice Administrator stated there was no documentation of supervision and collaboration for the non-physician practitioner.