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
▼ 163468 Van Horne Family Medical Clinic 205 Main Street Van Horne IA 7 (Kansas City) 05/26/2022 F6OJ11 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
▼ 163468 Van Horne Family Medical Clinic 205 Main Street Van Horne IA 7 (Kansas City) 08/19/2019 CBYJ11 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
J0044 Physical Plant And Environment Standard
▼ 163469 Lenox Medical Clinic 100 S Main Street Lenox IA 7 (Kansas City) 08/01/2019 TTGF11 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
▼ 163470 Burgess Family Clinc - Dunlap 612 Iowa Avenue Dunlap IA 7 (Kansas City) 09/04/2019 OGQU11 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
E0039 Ep Testing Requirements Standard
J0043 Physical Plant And Environment Standard
J0123 Staffing And Staff Responsibilities Standard
J0161 Program Evaluation Standard
J0162 Program Evaluation Standard
▼ 163472 Family Practice Clinic Graettinger 109 West Robbins Street Graettinger IA 7 (Kansas City) 07/05/2023 UOSF11 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
▼ 163472 Family Practice Clinic Graettinger 109 West Robbins Street Graettinger IA 7 (Kansas City) 09/24/2019 3RNS11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0007 Ep Program Patient Population Standard
E0039 Ep Testing Requirements Standard
▼ 163475 Mccrary Rost Clinic 1800 Main Street Gowrie IA 7 (Kansas City) 11/15/2022 G4C111 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
J0100 Staffing And Staff Responsibilities Standard
▼ 163475 Mccrary Rost Clinic 1800 Main Street Gowrie IA 7 (Kansas City) 09/25/2019 MDOV11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
E0031 Emergency Officials Contact Information Standard
E0036 Ep Training And Testing Standard
J0043 Physical Plant And Environment Standard
J0102 Staffing And Staff Responsibilities Standard
J0136 Provision Of Services Standard
J0153 Patient Health Records Standard
▼ 163476 Chi Health Clinic Dunlap 704 Iowa Avenue Dunlap IA 7 (Kansas City) 10/27/2022 XTPB11 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
J0043 Physical Plant And Environment Standard
J0044 Physical Plant And Environment Standard
▼ 163476 Chi Health Clinic Dunlap 704 Iowa Avenue Dunlap IA 7 (Kansas City) 09/23/2019 C5CG11 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
J0160 Program Evaluation Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
J0123 Staffing And Staff Responsibilities Standard
J0136 Provision Of Services Standard
J0161 Program Evaluation Standard
J0162 Program Evaluation Standard