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

Time Interval

Please select the calendar year or years for which you would like data.

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
▼ 523999 Kickapoo Valley Medical Clinic 102 Sunset Blvd Soldiers Grove WI 5 (Chicago) 09/06/2018 PD7411 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0037 Ep Training Program Standard
J0024 Location Of Clinic Standard
J0032 Basic Requirements Standard
▼ 528513 Muscoda Health Center 1075 N Wisconsin Ave Muscoda WI 5 (Chicago) 09/08/2020 UDEX11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0020 Policies For Evac. And Primary/Alt. Comm. Standard
▼ 528514 Richland Hospital Clinic 301 E 2nd St Suite 1c, 2b, 3b, 3c Richland Center WI 5 (Chicago) 11/07/2018 DNWV11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0101 Staffing And Staff Responsibilities Standard
J0125 Provision Of Services Standard
▼ 528518 Aspirus Owen Clinic 6 Johnson St Owen WI 5 (Chicago) 11/12/2024 7DOD11 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
▼ 528519 Aspirus Thorp Clinic 704 S Clark St Thorp WI 5 (Chicago) 04/07/2025 HP2K11 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
J0152 Patient Health Records Standard
▼ 528520 Gundersen Moundview Hospital & Clinics Friendship 402 W Lake St Friendship WI 5 (Chicago) 11/26/2018 ADFF11 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
▼ 528523 Gundersen Boscobel Area Hospital And Clinics 208 Parker St Boscobel WI 5 (Chicago) 07/24/2024 JBZY11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0160 Program Evaluation Condition
E0006 Plan Based On All Hazards Risk Assessment Standard
J0043 Physical Plant And Environment Standard
J0044 Physical Plant And Environment Standard
J0136 Provision Of Services Standard
J0152 Patient Health Records Standard
J0161 Program Evaluation Standard
J0162 Program Evaluation Standard
▼ 528525 River Valley Medical Clinic 436 Sunrise Dr Spring Green WI 5 (Chicago) 07/09/2024 QU5K11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0013 Development Of Ep Policies And Procedures Standard
E0020 Policies For Evac. And Primary/Alt. Comm. Standard
J0043 Physical Plant And Environment Standard
J0125 Provision Of Services Standard
▼ 528531 Door County Medical Ctr Sturgeon Bay Clinic 323 South 18th Ave Sturgeon Bay WI 5 (Chicago) 06/06/2023 7U1O11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0043 Physical Plant And Environment Standard
▼ 528533 Gundersen Boscobel Area Hsptl And Clinics Muscoda 525 N Wisconsin Ave Muscoda WI 5 (Chicago) 07/29/2024 1YIH11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0160 Program Evaluation Condition
E0006 Plan Based On All Hazards Risk Assessment Standard
E0020 Policies For Evac. And Primary/Alt. Comm. Standard
J0044 Physical Plant And Environment Standard
J0125 Provision Of Services Standard
J0136 Provision Of Services Standard
J0161 Program Evaluation Standard
J0162 Program Evaluation Standard