S&C QCOR RHC 2567s
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RHCs 2567s
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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
▼ 253814 L C Tennin, Jr, Md, Pa 122 East Academy Street Canton MS 4 (Atlanta) 01/24/2023 8RT511 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
J0150 Patient Health Records Condition
J0160 Program Evaluation Condition
E0004 Develop Ep Plan, Review And Update Annually Standard
E0013 Development Of Ep Policies And Procedures Standard
E0029 Development Of Communication Plan Standard
E0036 Ep Training And Testing Standard
J0013 Licensure/Cert/Registration Of Personnel Standard
J0042 Physical Plant And Environment Standard
J0101 Staffing And Staff Responsibilities Standard
J0110 Covid-19 Vaccination Of Facility Staff Standard
J0123 Staffing And Staff Responsibilities Standard
J0125 Provision Of Services Standard
J0135 Provision Of Services Standard
J0140 Provision Of Services Standard
J0151 Patient Health Records Standard
J0161 Program Evaluation Standard
J0162 Program Evaluation Standard
▼ 253855 Yazoo Family Clinic 1435 Grand Avenue Yazoo City MS 4 (Atlanta) 09/05/2019 7JDG11 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
▼ 253861 Rankin Rural Medical Clinic 129 Center Street, Suite B Richland MS 4 (Atlanta) 07/29/2019 P9QG11 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
▼ 253901 Ems Clinic 1604-B Leflore Avenue Greenwood MS 4 (Atlanta) 04/19/2018 294Q11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0076 Program Evaluation Condition
E0006 Plan Based On All Hazards Risk Assessment Standard
E0007 Ep Program Patient Population Standard
E0013 Development Of Ep Policies And Procedures Standard
E0036 Ep Training And Testing Standard
J0047 Physician Responsibilities Standard
J0051 Physician Assistant/Nurse Practitioner Responsibilities Standard
J0057 Patient Care Policies Standard
J0077 Annual Total Program Evaluation Standard
J0086 Staffing And Staff Responsibilities Standard
▼ 253923 Forest Family Practice Clinic ( Closed ) #1 Medical Lane Forest MS 4 (Atlanta) 08/09/2018 5SBU11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0019 Physical Plant And Environment Condition
J0052 Provision of Services Condition
J0021 Location Of Clinic Standard
J0024 Location Of Clinic Standard
J0054 Patient Care Policies Standard
▼ 258509 Arthur E Wood Medical Clinic 951 Matthew Drive, Suite D Waynesboro MS 4 (Atlanta) 10/29/2019 QVQW11 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
▼ 258516 Panola Family Specialty Clinic 303 Medical Center Drive Batesville MS 4 (Atlanta) 08/13/2025 2PIL11 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
▼ 258521 Mrh Medical Group Hamilton 40128 Hamilton Road Hamilton MS 4 (Atlanta) 03/06/2019 517M11 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
▼ 258529 Williams Medical Clinic Of Pot 39 Center St Box 40 Potts Camp MS 4 (Atlanta) 08/21/2018 6O1Y11 Standard
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not A Deficiency Citation Memo
J0000 Initial Comments - Not A Deficiency Citation Memo
J0057 Patient Care Policies Standard
J0062 Organizational Structure Standard
▼ 258535 Harrisville Medical Clinic 1652 Simpson Highway 469 / P.O. Box 469 Harrisville MS 4 (Atlanta) 09/27/2021 C7V811 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
J0101 Staffing And Staff Responsibilities Standard
J0123 Staffing And Staff Responsibilities Standard
J0152 Patient Health Records Standard