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 review of patients' test reports; surveyor observation; and interview with the laboratory director, test reports did not include the name and address of the laboratory location where the test was performed. Findings include: 1. At 10:30 AM, on May 14, 2019, the surveyor selected a total of 10 patients' test reports for review from January 2017 through February 2019. 2. Review of patients' test reports revealed that there was no documentation to show that patients test reports indicated the name and address location of where tests were performed for 8 of 10 patients' test reports reviewed. 3. The surveyor observed that after January 2017, documentation of the address location of where tests were performed was different than that of the location of this laboratory for 8 of 10 patients' test reports reviewed. 4. At 10:45 AM, on May 14, 2019, the laboratory director confirmed the surveyor's 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 --