Ascension Medical Group St Vincent - Dermatology

CLIA Laboratory Citation Details

2
Total Citations
2
Total Deficiencyies
2
Unique D-Tags
CMS Certification Number 15D2108281
Address 3801 Bellemeade Ave, Suite 120, Evansville, IN, 47714
City Evansville
State IN
Zip Code47714
Phone(812) 485-4200

Citation History (2 surveys)

Survey - April 29, 2026

Survey Type: null

Survey Event ID: DE9611

Deficiency Tags: D5217

Summary:

Summary Statement of Deficiencies D5217 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(c)(1) At least twice annually, the laboratory must verify the accuracy of any test or procedure it performs that is not included in subpart I of this part. This STANDARD is not met as evidenced by: Based on proficiency testing review, policy and procedure review, medical record review and interview, the laboratory failed to perform twice annual verification for KOH in 2025. Findings include: 1. Review of CAP proficiency testing showed no results for FSM-A 2025, KOH testing samples in 2025. 2. Policy titled, "KOH Proficiency testing", written on 04/01/2016 stated, "Twice annually The College of American Pathologist will send KOH proficiency kits to test the physician ' s ability to diagnosis various fungal specimen types. The answer sheet will be faxed to CAP ... Results will be kept on file in the laboratory ..." 3. A KOH fungal sample was analyzed microscopically on the following patient: Patient Collection Date Reported Results P1 11/18/2025 Hyphae Present 4. In an interview on 04/29/2026 at 4:15 pm, E1 (Office Manager) confirmed the laboratory had completed twice annual verification only once for KOH testing in 2025. Legend: CAP-College of American Pathologist E-Employee FSM-Fungal Smear KOH-Potassium Hydroxide Preparation P-Patient 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 --

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Survey - April 6, 2022

Survey Type: Standard

Survey Event ID: R9H411

Deficiency Tags: D0000

Summary:

Summary Statement of Deficiencies D0000 The laboratory was found to be in substantial compliance with CLIA regulations (42 CFR 493, effective April 24, 2003). No deficiencies were cited. 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 --

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