S&C QCOR RHC 2567s
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RHCs 2567s
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Time Interval

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Provider Characteristics

Use these filters if you want to limit the report to providers that have certain characteristics. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

Survey Type & Deficiency Tags

Use these filters if you want to limit the reports to providers on specific survey types, or to reports that were cited for specific RHC deficiency tags and tag types. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

CCN and Facility Name

Use these filters if you know the name (or partial name) of the facility you are searching for, or the CMS Certification Number (CCN) for the facility you are searching for.

Other Survey Characteristics

Select one of the options below to filter by surveys that cite deficiencies or by surveys that are deficiency-free. By default, only surveys that cite deficiencies are displayed. Selecting "All" displays all surveys.

CMS Certification Number Facility Name Address City State CMS Region Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
▼ 283844 Fillmore County Medical Center, Pc 1840 F Street Geneva NE 7 (Kansas City) 11/08/2021 W06111 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0001 Establishment Of The Emergency Program (Ep) Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
E0006 Plan Based On All Hazards Risk Assessment Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0013 Development Of Ep Policies And Procedures Standard
E0020 Policies For Evac. And Primary/Alt. Comm. Standard
E0022 Policies/Procedures For Sheltering In Place Standard
E0024 Policies/Procedures-Volunteers And Staffing Standard
E0029 Development Of Communication Plan Standard
E0030 Names And Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means For Communication Standard
E0033 Methods For Sharing Information Standard
E0034 Information On Occupancy/Needs Standard
J0125 Provision Of Services Standard
J0136 Provision Of Services Standard
J0161 Program Evaluation Standard
▼ 283868 Witter Family Medicine 358 S 10th, P O Box 110 David City NE 7 (Kansas City) 01/04/2022 ADCY11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0001 Establishment Of The Emergency Program (Ep) Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
E0006 Plan Based On All Hazards Risk Assessment Standard
E0007 Ep Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0013 Development Of Ep Policies And Procedures Standard
E0020 Policies For Evac. And Primary/Alt. Comm. Standard
E0022 Policies/Procedures For Sheltering In Place Standard
E0023 Policies/Procedures For Medical Documentation Standard
E0024 Policies/Procedures-Volunteers And Staffing Standard
E0029 Development Of Communication Plan Standard
E0030 Names And Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means For Communication Standard
E0033 Methods For Sharing Information Standard
E0034 Information On Occupancy/Needs Standard
E0036 Ep Training And Testing Standard
E0037 Ep Training Program Standard
E0039 Ep Testing Requirements Standard
J0042 Physical Plant And Environment Standard
J0123 Staffing And Staff Responsibilities Standard
▼ 283989 Grant Medical Clinic 912 Central Avenue Grant NE 7 (Kansas City) 07/25/2019 L34S11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0160 Program Evaluation Condition
J0135 Provision Of Services Standard
J0161 Program Evaluation Standard
J0162 Program Evaluation Standard
▼ 283997 Chimney Rock Medical Center 320 Main Bayard NE 7 (Kansas City) 02/08/2022 U4ZQ11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0001 Establishment Of The Emergency Program (Ep) Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
E0006 Plan Based On All Hazards Risk Assessment Standard
E0007 Ep Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0013 Development Of Ep Policies And Procedures Standard
E0020 Policies For Evac. And Primary/Alt. Comm. Standard
E0022 Policies/Procedures For Sheltering In Place Standard
E0023 Policies/Procedures For Medical Documentation Standard
E0024 Policies/Procedures-Volunteers And Staffing Standard
E0029 Development Of Communication Plan Standard
E0030 Names And Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means For Communication Standard
E0033 Methods For Sharing Information Standard
E0034 Information On Occupancy/Needs Standard
E0036 Ep Training And Testing Standard
E0037 Ep Training Program Standard
E0039 Ep Testing Requirements Standard
J0042 Physical Plant And Environment Standard
J0123 Staffing And Staff Responsibilities Standard
J0125 Provision Of Services Standard
J0136 Provision Of Services Standard
▼ 288503 Syracuse Area Health 7512 Highway 50 Weeping Water NE 7 (Kansas City) 01/24/2022 O1TE11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0001 Establishment Of The Emergency Program (Ep) Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
E0006 Plan Based On All Hazards Risk Assessment Standard
E0007 Ep Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0013 Development Of Ep Policies And Procedures Standard
E0020 Policies For Evac. And Primary/Alt. Comm. Standard
E0022 Policies/Procedures For Sheltering In Place Standard
E0023 Policies/Procedures For Medical Documentation Standard
E0024 Policies/Procedures-Volunteers And Staffing Standard
E0029 Development Of Communication Plan Standard
E0030 Names And Contact Information Standard
E0031 Emergency Officials Contact Information Standard
E0032 Primary/Alternate Means For Communication Standard
E0033 Methods For Sharing Information Standard
E0034 Information On Occupancy/Needs Standard
E0036 Ep Training And Testing Standard
E0037 Ep Training Program Standard
E0039 Ep Testing Requirements Standard
J0125 Provision Of Services Standard
J0136 Provision Of Services Standard
J0161 Program Evaluation Standard
▼ 288507 Avera Medical Group O'Neill 300 North 2nd Street O' Neill NE 7 (Kansas City) 11/29/2023 M1Y611 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0125 Provision Of Services Standard
▼ 288511 Greeley Medical Clinic 109 West O'Connor Avenue Greeley NE 7 (Kansas City) 03/05/2025 6K7111 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0100 Staffing And Staff Responsibilities Standard
▼ 288511 Greeley Medical Clinic 109 West O'Connor Avenue Greeley NE 7 (Kansas City) 03/08/2018 G8S211 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0062 Organizational Structure Standard
J0070 Records System Standard
▼ 288512 Cozad Community Medical Clinic P O Box 86, 1803 Papio Lane Cozad NE 7 (Kansas City) 06/04/2025 VUKG11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0125 Provision Of Services Standard
▼ 288518 Gage County Medical Clinic 1101 North 10th Street Beatrice NE 7 (Kansas City) 06/19/2018 VIUY12 Standard
Deficiency Tag Deficiency Description Tag Type
J0000 Initial Comments - Not A Deficiency Citation Memo
J0021 Location Of Clinic Standard
J0056 Patient Care Policies Standard