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
▼ 163433 Chi Health Clinic Missouri Valley 809 East Elm Street Missouri Valley IA 7 (Kansas City) 10/15/2019 687Q11 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
E0004 Develop Ep Plan, Review And Update Annually Standard
E0036 Ep Training And Testing Standard
E0039 Ep Testing Requirements Standard
J0043 Physical Plant And Environment Standard
J0152 Patient Health Records Standard
J0161 Program Evaluation Standard
J0162 Program Evaluation Standard
▼ 163435 Lineville Medical Clinic 101 Main Street Lineville IA 7 (Kansas City) 08/19/2025 TQWU11 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
J0085 Staffing And Staff Responsibilities Standard
J0100 Staffing And Staff Responsibilities Standard
▼ 163435 Lineville Medical Clinic 101 Main Street Lineville IA 7 (Kansas City) 10/30/2019 ORU311 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
J0040 Physical Plant And Environment Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
E0006 Plan Based On All Hazards Risk Assessment Standard
E0007 Ep Program Patient Population Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0020 Policies For Evac. And Primary/Alt. Comm. Standard
E0036 Ep Training And Testing Standard
E0039 Ep Testing Requirements Standard
J0041 Physical Plant And Environment Standard
J0042 Physical Plant And Environment Standard
J0043 Physical Plant And Environment Standard
J0100 Staffing And Staff Responsibilities Standard
J0123 Staffing And Staff Responsibilities Standard
J0136 Provision Of Services Standard
▼ 163437 Kossuth Regional Health Center 1519 South Phillips Street Algona IA 7 (Kansas City) 03/04/2021 L78211 Special, Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0153 Patient Health Records Standard
▼ 163438 Mercyone Arlington Family Medicine 751 Main Street Arlington IA 7 (Kansas City) 01/27/2021 L5NU11 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
▼ 163441 Cherokee Regional Clinic-Holstein 112 North Kiel Street Holstein IA 7 (Kansas City) 09/15/2021 MQ2T11 Special, Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0161 Program Evaluation Standard
▼ 163445 St Ansgar Clinic 140 West Fourth Street, Suite 1 Saint Ansgar IA 7 (Kansas City) 09/14/2021 3C3211 Special, Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0004 Develop Ep Plan, Review And Update Annually Standard
J0043 Physical Plant And Environment Standard
▼ 163449 Monroe Family Health Center 100 E Sherman Monroe IA 7 (Kansas City) 12/20/2018 T3D311 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0004 Develop Ep Plan, Review And Update Annually Standard
E0009 Local, State, Tribal Collaboration Process Standard
E0029 Development Of Communication Plan Standard
E0039 Ep Testing Requirements Standard
J0043 Physical Plant And Environment Standard
J0044 Physical Plant And Environment Standard
▼ 163452 Farmington Medical Clinic 206 South Fourth Street Farmington IA 7 (Kansas City) 02/03/2021 6YZC11 Special, 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
J0043 Physical Plant And Environment Standard
▼ 163452 Farmington Medical Clinic 206 South Fourth Street Farmington IA 7 (Kansas City) 08/20/2019 25KW11 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
E0029 Development Of Communication Plan Standard