S&C QCOR RHC 2567s
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RHCs 2567s
Selection Criteria ▸

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
▼ 513991 Summers County Arh Clinic 115 Summers Hospital Road Hinton WV 3 (Philadelphia) 11/12/2024 KNZ911 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0135 Provision Of Services Standard
▼ 513991 Summers County Arh Clinic 115 Summers Hospital Road Hinton WV 3 (Philadelphia) 10/26/2020 QUIT11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0135 Provision Of Services Standard
▼ 513992 Bmh Family Medical Center 697 Madison Avenue Madison WV 3 (Philadelphia) 07/16/2019 8NJE11 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
J0125 Provision Of Services Standard
J0135 Provision Of Services Standard
▼ 513998 Minnie Hamilton Health System 186 Hospital Drive Grantsville WV 3 (Philadelphia) 12/09/2024 N30D11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0135 Provision Of Services Standard
▼ 513998 Minnie Hamilton Health System 186 Hospital Drive Grantsville WV 3 (Philadelphia) 02/26/2020 SCZ311 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
J0135 Provision Of Services Standard
▼ 523810 Aurora Health Center Sister Bay 2521 S Bay Shore Dr Sister Bay WI 5 (Chicago) 09/20/2022 375411 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
J0060 Organizational Structure Condition
J0080 Staffing And Staff Responsibilities Condition
J0120 Provision Of Services Condition
J0160 Program Evaluation Condition
J0062 Organizational Structure Standard
J0101 Staffing And Staff Responsibilities Standard
J0123 Staffing And Staff Responsibilities Standard
J0124 Provision Of Services Standard
J0125 Provision Of Services Standard
J0140 Provision Of Services Standard
J0161 Program Evaluation Standard
▼ 523865 Fmc Algoma 831 Parker Ave Algoma WI 5 (Chicago) 09/16/2019 R50X11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0006 Plan Based On All Hazards Risk Assessment Standard
▼ 523981 Memorial Medical Ctr Greenwood 201 S Main St Greenwood WI 5 (Chicago) 04/24/2018 9SWL11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0076 Program Evaluation Condition
J0080 Staffing And Staff Responsibilities Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
E0007 Ep Program Patient Population Standard
E0032 Primary/Alternate Means For Communication Standard
J0039 Staffing Standard
J0051 Physician Assistant/Nurse Practitioner Responsibilities Standard
J0061 Organizational Structure Standard
J0062 Organizational Structure Standard
J0077 Annual Total Program Evaluation Standard
J0079 Evaluation Review Criteria Standard
J0081 Staffing And Staff Responsibilities Standard
J0082 Staffing And Staff Responsibilities Standard
J0083 Staffing And Staff Responsibilities Standard
J0084 Staffing And Staff Responsibilities Standard
J0085 Staffing And Staff Responsibilities Standard
▼ 523998 Mayo Clinic Health System Sparta 310 W Main St Sparta WI 5 (Chicago) 11/14/2023 CV9L11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0151 Patient Health Records Standard
▼ 523999 Kickapoo Valley Medical Clinic 102 Sunset Blvd Soldiers Grove WI 5 (Chicago) 07/09/2025 3E3811 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0044 Physical Plant And Environment Standard
J0125 Provision Of Services Standard