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
▼ 153804 Clay City Center For Family Medicine 315 Lankford St Clay City IN 5 (Chicago) 06/11/2025 B0W611 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
J0044 Physical Plant And Environment Standard
J0123 Staffing And Staff Responsibilities Standard
▼ 153804 Clay City Center For Family Medicine 315 Lankford St Clay City IN 5 (Chicago) 03/26/2019 MZJW11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0042 Physical Plant And Environment Standard
J0044 Physical Plant And Environment Standard
▼ 153823 Redi-Care Inc Pc 2120 N Detroit St Lagrange IN 5 (Chicago) 09/14/2021 JLZV11 Special, 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
J0011 Compliance With Fed., State & Local Laws Standard
J0062 Organizational Structure Standard
J0136 Provision Of Services Standard
J0161 Program Evaluation Standard
▼ 153828 Monticello Medical Center 826 N Sixth St Monticello IN 5 (Chicago) 09/30/2021 DY8E11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0042 Integrated Ep Program Standard
J0043 Physical Plant And Environment Standard
J0044 Physical Plant And Environment Standard
J0136 Provision Of Services Standard
▼ 153829 Adams Medical Group - Berne 1521 W Main St Berne IN 5 (Chicago) 09/26/2019 BPEF11 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
J0125 Provision Of Services Standard
▼ 153843 Deaconess Clinic Inc 1004 East Illinois Street Petersburg IN 5 (Chicago) 05/25/2021 7ZMZ11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0042 Physical Plant And Environment Standard
J0044 Physical Plant And Environment Standard
J0152 Patient Health Records Standard
▼ 153857 Knox Family Medical Center 104 Culver Road, Suite 102 Knox IN 5 (Chicago) 08/29/2023 Z84H11 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
J0120 Provision Of Services Condition
J0062 Organizational Structure Standard
▼ 153857 Knox Family Medical Center 104 Culver Road, Suite 102 Knox IN 5 (Chicago) 09/28/2018 W81O11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0055 Patient Care Policies Standard
▼ 153859 Dale Family Medicine 4 W Vine St Dale IN 5 (Chicago) 10/08/2024 Z2M011 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
J0152 Patient Health Records Standard
▼ 153859 Dale Family Medicine 4 W Vine St Dale IN 5 (Chicago) 10/02/2018 VE9811 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0022 Location Of Clinic Standard
J0023 Location Of Clinic Standard
J0055 Patient Care Policies Standard