S&C QCOR CLIA 2567s
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CLIA 2567s
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Time Interval

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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

Use these filters if you know the name (or partial name) of 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 Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
▼ 52D0397042 Northlakes Community Clinic 15954 Rivers Edge Dr Hayward WI 11/07/2018 N8O211 Standard
Deficiency Tag Deficiency Description Tag Type
D5409 PROCEDURE MANUAL Standard
D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5421 ESTABLISHMENT AND VERIFICATION OF PERFORMANCE Standard
D5805 TEST REPORT Standard
D6026 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6031 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6063 LABORATORY TESTING PERSONNEL Condition
D6065 TESTING PERSONNEL QUALIFICATIONS Standard
▼ 52D0397042 Northlakes Community Clinic 15954 Rivers Edge Dr Hayward WI 12/03/2020 ECUF11 Standard
Deficiency Tag Deficiency Description Tag Type
D6033 TECHNICAL CONSULTANT-MODERATE COMPLEXITY Condition
D6035 TECHNICAL CONSULTANT QUALIFICATIONS Standard
D6046 TECHNICAL CONSULTANT RESPONSIBILITIES Standard
▼ 52D0397042 Northlakes Community Clinic 15954 Rivers Edge Dr Hayward WI 11/15/2022 XVLI11 Standard
Deficiency Tag Deficiency Description Tag Type
D5805 TEST REPORT Standard
▼ 52D0397042 Northlakes Community Clinic 15954 Rivers Edge Dr Hayward WI 08/14/2024 S5WI11 Standard
Deficiency Tag Deficiency Description Tag Type
D5421 ESTABLISHMENT AND VERIFICATION OF PERFORMANCE Standard
▼ 52D0397081 Northlakes Community Clinic 600 Shell Creek Rd Minong WI 11/07/2018 Z70811 Standard
Deficiency Tag Deficiency Description Tag Type
D5409 PROCEDURE MANUAL Standard
D5805 TEST REPORT Standard
D6063 LABORATORY TESTING PERSONNEL Condition
D6065 TESTING PERSONNEL QUALIFICATIONS Standard
▼ 52D0397081 Northlakes Community Clinic 600 Shell Creek Rd Minong WI 12/03/2020 ZWB011 Standard
Deficiency Tag Deficiency Description Tag Type
D6033 TECHNICAL CONSULTANT-MODERATE COMPLEXITY Condition
D6035 TECHNICAL CONSULTANT QUALIFICATIONS Standard
▼ 52D0397081 Northlakes Community Clinic 600 Shell Creek Rd Minong WI 11/14/2022 954211 Standard
Deficiency Tag Deficiency Description Tag Type
D5217 EVALUATION OF PROFICIENCY TESTING PERFORMANCE Standard
▼ 52D0397081 Northlakes Community Clinic 600 Shell Creek Rd Minong WI 08/14/2024 VWBM11 Standard
Deficiency Tag Deficiency Description Tag Type
D6046 TECHNICAL CONSULTANT RESPONSIBILITIES Standard
▼ 52D0397432 Mosaic Family Health Center 229 S Morrison St Appleton WI 11/06/2024 UDU911 Standard
Deficiency Tag Deficiency Description Tag Type
D3031 RETENTION REQUIREMENTS Standard
▼ 52D0397433 Encircle Health Thedacare Physician Laboratory 2500 E Capitol Dr Appleton WI 02/27/2019 6LH411 Standard
Deficiency Tag Deficiency Description Tag Type
D2007 TESTING OF PROFICIENCY TESTING SAMPLES Standard
D5421 ESTABLISHMENT AND VERIFICATION OF PERFORMANCE Standard