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 B03837 (X3) Date Survey Completed 03/25/2021
Name of Provider or Supplier Kentucky Family Medicine Street Address, City, State 706 Manor St, Corbin, KY
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 Emergency Preparedness survey was conducted on 03/25/2021. The facility was found to be in compliance with 42 CFR 491.12 Emergency Preparedness with no deficiencies identified.