Summary:
Summary Statement of Deficiencies D5805 TEST REPORT CFR(s): 493.1291(c) (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 the review of the laboratory's patient case logs, patient MOHS reports from 09/15/2025 to 12/29/2025, and confirmed in an interview, the laboratory failed to include the name and the address of the laboratory where the MOHS procedure was performed for 4 of 4 patient MOHS reports reviewed. The findings were: 1. Review of the laboratory's patient case logs revealed the laboratory 1st MOHS case was on 09/15 /2025. 2. Random review of the laboratory's patient MOHS reports from 09/15/2025 to 12/29/2025 revealed the laboratory failed to include the name and the address of the laboratory where the MOHS procedure was performed for 4 of 4 patient MOHS reports reviewed. 09/15/2025 Case#: AA25-001 09/15/2025 Case#: AA25-002 12/19 /2025 Case#: AA25-019 12/19/2025 Case#: AA25-022 3. In an interview on 02/04 /2026 at 11:00 am in the break room, the practice manager confirmed the above findings. 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 --