Summary:
Summary Statement of Deficiencies D0000 A CLIA initial survey was conducted for the Mosher Center laboratory on 12/08/2025 pursuant to the Clinical Laboratory Improvement Act (CLIA) of 1988 and CLIA regulations at 42 CFR CFR 493. 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 record review and interview with the Laboratory Director (LD) on 12/08 /2025, the laboratory failed to indicate on the patient final test report the correct name of the laboratory where the test was performed as evidenced by the following: The surveyor reviewed six (6) patient final test reports between August 2024 and October 2025 in the Electronic Medical Record (EMR) Epic. The review revealed that the laboratory failed to indicate the correct name of the laboratory where the test was performed for six (6) out of six (6) patient final test reports. The name of the laboratory on the patient's final test reports in the Epic EMR was New England Ear Nose & Throat. The laboratory's name on the CLIA certificate was Maritime Mohs until 12/07/2025. NOTE: The laboratory changed its name to Mosher Center effective 12/08/2025. The LD confirmed in an interview on 12/08/2025 at 3:40 P.M. that the patient final test reports did not indicate the correct name of the laboratory where the test was performed. The laboratory performs 1,138 Mohs cases annually. 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 --