Summary:
Summary Statement of Deficiencies D0000 An announced CLIA initial survey was conducted at Advanced Dermatology & Cosmetic Surgery on 03/03/2022. The laboratory is not in compliance with 42 CFR Part 493, Requirements for Laboratories. The following is a description of the standard level deficiencies: D5805 TEST REPORT CFR(s): 493.1291(c) The test report must indicate the following: (c)(1) For positive patient identification, either the patient's name and identification number, or a unique patient identifier and identification number. (c)(2) The name and address of the laboratory location where the test was performed. (c)(3) The test report date. (c)(4) The test performed. (c)(5) Specimen source, when appropriate. (c)(6) The test result and, if applicable, the units of measurement or interpretation, or both. (c)(7) Any information regarding the condition and disposition of specimens that do not meet the laboratory's criteria for acceptability. This STANDARD is not met as evidenced by: Based on record review and interview with the location manager, the laboratory failed to include the name of the laboratory where the testing was performed on 4 out of 4 patient operative (op) reports reviewed. Findings Included: Review of patient reports dated 7/30/2021, 09/07/2021, 11/02/21, and 01/07/2022 revealed none of the reports included the name of the laboratory where the testing was performed. On 03/03/2022 at 11:30 AM, the location manager confirmed that the patient reports did not have the correct name of the laboratory for the 4 patient operative reports reviewed. Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 1 --