S&C QCOR CLIA 2567s
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CLIA 2567s
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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 CLIA 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).

CLIA ID and Facility Name

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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 Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
▼ 52D0396363 Krohn Clinic Ltd 610 W Adams St Black River Falls WI 01/31/2024 Y9YV11 Standard
Deficiency Tag Deficiency Description Tag Type
D5439 CALIBRATION AND CALIBRATION VERIFICATION Standard
D5451 CONTROL PROCEDURES Standard
▼ 52D0396419 Gundersen Health System Onalaska Clinic 3111 Gundersen Dr Onalaska WI 05/14/2024 OKMR11 Standard
Deficiency Tag Deficiency Description Tag Type
D5407 PROCEDURE MANUAL Standard
D5409 PROCEDURE MANUAL Standard
D6070 TESTING PERSONNEL RESPONSIBILITIES Standard
▼ 52D0396419 Gundersen Health System Onalaska Clinic 3111 Gundersen Dr Onalaska WI 12/03/2025 EFD811 Standard
Deficiency Tag Deficiency Description Tag Type
D5203 SPECIMEN IDENTIFICATION AND INTEGRITY Standard
D5403 PROCEDURE MANUAL Standard
D6070 TESTING PERSONNEL RESPONSIBILITIES Standard
▼ 52D0396431 Kickapoo Valley Medical Clinic-Vmh 102 Sunset Ave Soldiers Grove WI 01/03/2018 2XUO12 Standard
Deficiency Tag Deficiency Description Tag Type
D5401 PROCEDURE MANUAL null
▼ 52D0396431 Kickapoo Valley Medical Clinic-Vmh 102 Sunset Ave Soldiers Grove WI 01/26/2022 P1H411 Standard
Deficiency Tag Deficiency Description Tag Type
D6031 LABORATORY DIRECTOR RESPONSIBILITIES Standard
▼ 52D0396431 Kickapoo Valley Medical Clinic-Vmh 102 Sunset Ave Soldiers Grove WI 11/28/2023 JA2611 Standard
Deficiency Tag Deficiency Description Tag Type
D5217 EVALUATION OF PROFICIENCY TESTING PERFORMANCE Standard
D5407 PROCEDURE MANUAL Standard
▼ 52D0396431 Kickapoo Valley Medical Clinic-Vmh 102 Sunset Ave Soldiers Grove WI 01/22/2026 00JZ11 Standard
Deficiency Tag Deficiency Description Tag Type
D5217 EVALUATION OF PROFICIENCY TESTING PERFORMANCE Standard
▼ 52D0396448 Gundersen Health System Sparta Clinic 1111 West Wisconsin Street Sparta WI 05/15/2024 B0GT11 Standard
Deficiency Tag Deficiency Description Tag Type
D3031 RETENTION REQUIREMENTS Standard
D5209 PERSONNEL COMPETENCY ASSESSMENT POLICIES Standard
▼ 52D0396462 Gundersen Health System Tomah Clinic 505 Gopher Drive Tomah WI 05/22/2024 CQKB11 Standard
Deficiency Tag Deficiency Description Tag Type
D5209 PERSONNEL COMPETENCY ASSESSMENT POLICIES Standard
D6047 TECHNICAL CONSULTANT RESPONSIBILITIES Standard
▼ 52D0396462 Gundersen Health System Tomah Clinic 505 Gopher Drive Tomah WI 09/30/2025 5LRM11 Standard
Deficiency Tag Deficiency Description Tag Type
D5209 PERSONNEL COMPETENCY ASSESSMENT POLICIES Standard