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
▼ 153938 Access Medical Clinic Indiana 1641 South Us Hwy 231 Crawfordsville IN 5 (Chicago) 02/07/2025 CDNU11 Complaint
Deficiency Tag Deficiency Description Tag Type
J0000 Initial Comments - Not A Deficiency Citation Memo
J0041 Physical Plant And Environment Standard
J0044 Physical Plant And Environment Standard
▼ 153979 Kentland Clinic 303 N 7th Kentland IN 5 (Chicago) 09/29/2021 T6HP11 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
J0160 Program Evaluation Condition
J0011 Compliance With Fed., State & Local Laws Standard
J0043 Physical Plant And Environment Standard
J0062 Organizational Structure Standard
J0123 Staffing And Staff Responsibilities Standard
J0125 Provision Of Services Standard
J0136 Provision Of Services Standard
▼ 153987 Knightstown Family Health Care 224 W Main St Knightstown IN 5 (Chicago) 08/21/2023 Y6TT11 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
J0160 Program Evaluation Condition
J0062 Organizational Structure Standard
▼ 153987 Knightstown Family Health Care 224 W Main St Knightstown IN 5 (Chicago) 09/13/2018 8O1J11 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
J0023 Location Of Clinic Standard
J0062 Organizational Structure Standard
J0070 Records System Standard
J0072 Protection of Record Information Standard
▼ 153990 Franciscan Wheatfield Health Center 492 S Bierma St Wheatfield IN 5 (Chicago) 08/13/2019 P3SL11 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
▼ 153993 St Vincent North Clinic 1731 Ringer Ln Williamsport IN 5 (Chicago) 09/28/2021 0FZ711 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
E0007 Ep Program Patient Population 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
E0032 Primary/Alternate Means For Communication Standard
E0033 Methods For Sharing Information Standard
E0034 Information On Occupancy/Needs Standard
E0042 Integrated Ep Program Standard
J0043 Physical Plant And Environment Standard
J0044 Physical Plant And Environment Standard
J0161 Program Evaluation Standard
▼ 153999 North Daviess Medical Clinic 202 N West St Odon IN 5 (Chicago) 07/28/2021 939111 Special, 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
J0152 Patient Health Records Standard
J0161 Program Evaluation Standard
▼ 158500 Dch Medical Clinic 1400 Grand Ave Washington IN 5 (Chicago) 08/10/2022 LCVT11 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
J0044 Physical Plant And Environment Standard
J0110 Covid-19 Vaccination Of Facility Staff Standard
▼ 158502 Franciscan Brook Health Center 420 E Main St Po Box 118 Brook IN 5 (Chicago) 09/28/2021 I21R11 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
J0044 Physical Plant And Environment Standard
J0084 Staffing And Staff Responsibilities Standard
J0136 Provision Of Services Standard
▼ 158503 Grand Avenue Pediatrics 1402 Grand Ave Washington IN 5 (Chicago) 11/07/2024 BF1A11 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