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
▼ 158559 Adams Medical Group - Berne 1521 W Main St Berne IN 5 (Chicago) 09/26/2019 5SK311 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
▼ 163400 Wall Lake Medical Clinic 311 West First Street Wall Lake IA 7 (Kansas City) 09/01/2022 4CE711 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0080 Staffing And Staff Responsibilities Condition
J0100 Staffing And Staff Responsibilities Standard
J0101 Staffing And Staff Responsibilities Standard
▼ 163400 Wall Lake Medical Clinic 311 West First Street Wall Lake IA 7 (Kansas City) 08/01/2019 UC8911 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0040 Physical Plant And Environment Condition
J0080 Staffing And Staff Responsibilities Condition
J0120 Provision Of Services Condition
J0150 Patient Health Records Condition
J0160 Program Evaluation Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
E0020 Policies For Evac. And Primary/Alt. Comm. Standard
E0029 Development Of Communication Plan Standard
E0031 Emergency Officials Contact Information Standard
E0036 Ep Training And Testing Standard
E0039 Ep Testing Requirements Standard
J0043 Physical Plant And Environment Standard
J0044 Physical Plant And Environment Standard
J0085 Staffing And Staff Responsibilities Standard
J0100 Staffing And Staff Responsibilities Standard
J0125 Provision Of Services Standard
J0152 Patient Health Records Standard
J0153 Patient Health Records Standard
J0161 Program Evaluation Standard
J0162 Program Evaluation Standard
▼ 163410 Health Trust Physicians Clinic 300 West Hutchins Street Winterset IA 7 (Kansas City) 05/21/2024 GU4N11 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
▼ 163410 Health Trust Physicians Clinic 300 West Hutchins Street Winterset IA 7 (Kansas City) 03/03/2022 F5O211 Complaint
Deficiency Tag Deficiency Description Tag Type
J0000 Initial Comments - Not A Deficiency Citation Memo
J0013 Licensure/Cert/Registration Of Personnel Standard
▼ 163410 Health Trust Physicians Clinic 300 West Hutchins Street Winterset IA 7 (Kansas City) 03/23/2021 BKOJ11 Special, Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0041 Physical Plant And Environment Standard
▼ 163410 Health Trust Physicians Clinic 300 West Hutchins Street Winterset IA 7 (Kansas City) 07/08/2019 6B2311 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
▼ 163417 Family Practice Clinic West Bend 107 Division Street West Bend IA 7 (Kansas City) 09/04/2019 N0GB11 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
J0060 Organizational Structure Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
J0042 Physical Plant And Environment Standard
J0043 Physical Plant And Environment Standard
J0044 Physical Plant And Environment Standard
J0061 Organizational Structure Standard
J0161 Program Evaluation Standard
▼ 163420 Franklin Medical Center-Hampton 1720 Central Avenue East Hampton IA 7 (Kansas City) 07/07/2022 1TP311 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
E0037 Ep Training Program Standard
E0039 Ep Testing Requirements Standard
J0043 Physical Plant And Environment Standard
J0152 Patient Health Records Standard
J0161 Program Evaluation Standard
▼ 163420 Franklin Medical Center-Hampton 1720 Central Avenue East Hampton IA 7 (Kansas City) 09/04/2019 TYDY11 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
J0161 Program Evaluation Standard