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 the review of a patient urinalysis (UA) report from the facility's electronic medical record (EMR), procedure manual and interview, the laboratory failed to have a test report that included the units of measurement for: UA glucose, UA ketone, UA protein, UA WBC (white blood cells), UA RBC (red blood cells), UA mucous, UA bacteria, UA casts, and UA epithelial cells. Findings: 1. Review of a patient test report from the EMR showed no units of measurement for UA glucose, UA ketone, UA protein, UA WBC, UA RBC, UA mucous, UA bacteria, UA casts, UA crystals and UA epithelial cells. 2. The procedure "Urinalysis" listed units of measurement for: a. UA glucose, UA ketone, and UA protein as mg/dL. b. UA WBC, UA RBC, UA mucous, UA bacteria, UA crystals and UA epithelial cells as per high power field (HPF). c. UA casts as per low power field (LPF). 3. Interview with technical supervisor #2 on 8/9/22 on 11 a.m. confirmed, the laboratory failed to have a test report that included the units of measurement for UA glucose, UA ketone, UA protein, UA WBC (white blood cells), UA RBC (red blood cells), UA mucous, UA bacteria, UA casts, and UA epithelial cells. 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 --