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
▼ 64D1048456 American Samoa Dept Of Health Clinical Lab 3965 Petesa Rd Tafuna Village Pago Pago AS 08/14/2025 IRW011 Standard
Deficiency Tag Deficiency Description Tag Type
D0000 Initial Comments - Not A Deficiency Citation Memo
D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5431 MAINTENANCE AND FUNCTION CHECKS Standard
D5445 CONTROL PROCEDURES Standard
D5481 CONTROL PROCEDURES Standard
▼ 65D0662216 Guam Dept Public Hlth & Soc Svcs Central Lab 761 South Marine Corps Drive, 3rd Floor Tamuning GU 09/24/2021 P4VR11 Standard
Deficiency Tag Deficiency Description Tag Type
D6063 LABORATORY TESTING PERSONNEL Condition
D6065 TESTING PERSONNEL QUALIFICATIONS Standard
D6168 TESTING PERSONNEL Condition
D6171 TESTING PERSONNEL QUALIFICATIONS Standard
▼ 65D0662216 Guam Dept Public Hlth & Soc Svcs Central Lab 761 South Marine Corps Drive, 3rd Floor Tamuning GU 07/17/2025 XN6N11 Standard
Deficiency Tag Deficiency Description Tag Type
D0000 Initial Comments - Not A Deficiency Citation Memo
D3005 FACILITIES Standard
D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5415 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
▼ 65D0662219 Diagnostic Lab Services, Inc - Itc 590 S Marine Corps Dr Tamuning GU 09/23/2021 1ZVR11 Standard
Deficiency Tag Deficiency Description Tag Type
D5401 PROCEDURE MANUAL Standard
D5403 PROCEDURE MANUAL Standard
D5807 TEST REPORT Standard
D6094 LABORATORY DIRECTOR RESPONSIBILITIES Standard
▼ 65D0662219 Diagnostic Lab Services, Inc - Itc 590 S Marine Corps Dr Tamuning GU 05/04/2023 X29D11 Standard
Deficiency Tag Deficiency Description Tag Type
D5793 ANALYTIC SYSTEMS QUALITY ASSESSMENT Standard
▼ 65D0662219 Diagnostic Lab Services, Inc - Itc 590 S Marine Corps Dr Tamuning GU 07/15/2025 TKWL11 Standard
Deficiency Tag Deficiency Description Tag Type
D0000 Initial Comments - Not A Deficiency Citation Memo
D5311 SPECIMEN SUBMISSION, HANDLING, AND REFERRAL Standard
D5401 PROCEDURE MANUAL Standard
D5403 PROCEDURE MANUAL Standard
D5411 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5473 CONTROL PROCEDURES Standard
D5543 HEMATOLOGY Standard
D5781 CORRECTIVE ACTIONS Standard
D6139 CLINICAL CONSULTANT RESPONSIBILITIES Standard
▼ 65D0669318 Guam Seventh Day Adventist Clinic Laboratory 388 Ypao Road Tamuning GU 09/22/2021 4JGB11 Standard
Deficiency Tag Deficiency Description Tag Type
D5403 PROCEDURE MANUAL Standard
D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5415 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5439 CALIBRATION AND CALIBRATION VERIFICATION Standard
D5805 TEST REPORT Standard
▼ 65D0669318 Guam Seventh Day Adventist Clinic Laboratory 388 Ypao Road Tamuning GU 07/18/2025 D71Q11 Standard
Deficiency Tag Deficiency Description Tag Type
D0000 Initial Comments - Not A Deficiency Citation Memo
D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT Standard
D5435 MAINTENANCE AND FUNCTION CHECKS Standard
D5783 CORRECTIVE ACTIONS Standard
D6168 TESTING PERSONNEL Condition
D6171 TESTING PERSONNEL QUALIFICATIONS Standard
▼ 65D0862073 Guam Memorial Hospital Blood Gas Lab 850 Gov Carlos G Camacho Rd Tamuning GU 05/12/2021 5RGZ11 Standard
Deficiency Tag Deficiency Description Tag Type
D2009 TESTING OF PROFICIENCY TESTING SAMPLES Standard
D2016 SUCCESSFUL PARTICIPATION Condition
D2121 HEMATOLOGY Standard
D2130 HEMATOLOGY Standard
D6000 MODERATE COMPLEXITY LABORATORY DIRECTOR Condition
D6016 LABORATORY DIRECTOR RESPONSIBILITIES Standard
▼ 65D0862073 Guam Memorial Hospital Blood Gas Lab 850 Gov Carlos G Camacho Rd Tamuning GU 05/01/2023 D5V311 Standard
Deficiency Tag Deficiency Description Tag Type
D5400 ANALYTIC SYSTEMS Condition
D5403 PROCEDURE MANUAL Standard
D5481 CONTROL PROCEDURES Standard
D5775 COMPARISON OF TEST RESULTS Standard
D5791 ANALYTIC SYSTEMS QUALITY ASSESSMENT Standard
D6000 MODERATE COMPLEXITY LABORATORY DIRECTOR Condition
D6019 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6020 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6021 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6030 LABORATORY DIRECTOR RESPONSIBILITIES Standard
D6031 LABORATORY DIRECTOR RESPONSIBILITIES Standard