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
▼ 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
▼ 528533 Gundersen Boscobel Area Hsptl And Clinics Muscoda 525 N Wisconsin Ave Muscoda WI 5 (Chicago) 01/23/2018 WGDE11 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
J0023 Location Of Clinic Standard
J0072 Protection of Record Information Standard
▼ 528534 Gundersen Boscobel Area Hsptl & Clinics Fennimore 220 Lincoln Ave Fennimore WI 5 (Chicago) 08/12/2025 8M2411 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0039 Ep Testing Requirements Standard
J0042 Physical Plant And Environment Standard
▼ 528534 Gundersen Boscobel Area Hsptl & Clinics Fennimore 220 Lincoln Ave Fennimore WI 5 (Chicago) 09/20/2018 NAV011 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0020 Location Of Clinic Condition
J0032 Basic Requirements Standard
▼ 528535 Aspirus Gilman Clinic 320 East Main St Gilman WI 5 (Chicago) 03/07/2018 5JWJ11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0054 Patient Care Policies Standard
J0062 Organizational Structure Standard
J0072 Protection of Record Information Standard
▼ 528536 Aspirus Prentice Clinic 1511 Railroad Ave Prentice WI 5 (Chicago) 12/10/2024 919B11 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
▼ 528536 Aspirus Prentice Clinic 1511 Railroad Ave Prentice WI 5 (Chicago) 04/09/2018 E0SG11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0023 Location Of Clinic Standard
J0070 Records System Standard
▼ 528537 Aspirus Phillips Clinic 625 Peterson Ave Phillips WI 5 (Chicago) 08/27/2018 M2XU11 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