Summary:
Summary Statement of 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 Mohs Technician, the laboratory failed to include the name of the laboratory on its test reports for 8 (JV21-2, JV22-12, JV22-84, JV22-162, JV22-213, JV22-240, JV22-301, and JV22-334) of 8 patient test reports reviewed. Findings include: 1. A review of the laboratory's patient test reports revealed a lack of the laboratory's name on the following patient test reports for mohs histopathology testing: a. Patient JV21-2 issued 11/16/21. b. Patient JV22-12 issued 1 /11/22. c. Patient JV22-84 issued 3/3/22. d. Patient JV22-162 issued 5/3/22. e. Patient JV22-213 issued 6/21/22. f. Patient JV22-240 issued 7/21/22. g. Patient JV22-301 issued 11/17/22. h. Patient JV22-334 issued 12/8/22. 2. An interview on 12/14/22 at 1: 39 pm with the Mohs Technician confirmed the laboratory name was not present on the mohs histopathology testing reports for the patients listed above. 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 --