Summary:
Summary Statement of Deficiencies D5305 TEST REQUEST CFR(s): 493.1241(c) The laboratory must ensure the test requisition solicits the following information: (1) The name and address or other suitable identifiers of the authorized person requesting the test and, if appropriate, the individual responsible for using the test results, or the name and address of the laboratory submitting the specimen, including, as applicable, a contact person to enable the reporting of imminently life threatening laboratory results or panic or alert values. (2) The patient's name or unique patient identifier. (3) The sex and age or date of birth of the patient. (4) The test(s) to be performed. (5) The source of the specimen, when appropriate. (6) The date and, if appropriate, time of specimen collection. (7) For Pap smears, the patient's last menstrual period, and indication of whether the patient had a previous abnormal report, treatment, or biopsy. (8) Any additional information relevant and necessary for a specific test to ensure accurate and timely testing and reporting of results, including interpretation, if applicable. This STANDARD is not met as evidenced by: Based on review of the patient test manifest, interview with the technical consultant, and the testing person, the laboratory did not update the patient test manifest with the laboratory's current address when patient specimens were referred for toxicology testing. Findings: 1. The laboratory moved to a new location in November 2017. 2. The laboratory manifest for referring facilities to summit patient samples for testing had the former address on the test request manifest and was not updated with the new laboratory location where testing is performed. 3. The testing person stated that they requested an address change but the technician only updated the patient final report address and he unaware that the test request manifest did not have the current laboratory location on the form. 4. The technical consultation stated that she was not aware the old address was still present on the test request manifest. 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 --