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 B03922 (X3) Date Survey Completed 04/19/2023
Name of Provider or Supplier Minuteman Medicine Llc Street Address, City, State 17721 Ky Route 122, Hi Hat, 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)
J0000 An initial certification survey was conducted on 04/19/2023. The facility was found to not be in substantial compliance with federal certification requirements related to Rural Health Clinics, with deficiencies cited.