Marvin D Siegel Md Pc

Summary Statement of Deficiencies D5803 TEST REPORT CFR(s): 493.1291(b) Test report information maintained as part of the patient's chart or medical record must be readily available to the laboratory and to CMS or a CMS agent upon request. This STANDARD is not met as evidenced by: . Based on record review, lack of documentation, and interview with the Laboratory Liaison (LL), the laboratory failed to have available for the surveyor the patient's final test report information maintained as part of patients' electronic medical record (EMR) for 8 ( #1 - #6, #10, and #20) of 24 patient records reviewed. Findings include: 1. A record review for 8 ( #1 - #6, #10, and #20) of 24 patient records reviewed revealed a lack of documentation in the EMR system as follows: a. Patient #1 - no final dermatophyte test media (DTM) results in the EMR for testing date 6/27/2019 b. Patient #2 - no final DTM result in the EMR for testing date 9/20/2019 c. Patient #3 - no final DTM result in the EMR for testing date 7/24/2020 d. Patient #4 - no final DTM result in the EMR for testing date 10/16/2020 e. Patient #5 - no final DTM result in the EMR for testing date 1/09/2021 f. Patient #6 - no final DTM result in the EMR for testing date 3/26/2021 g. Patient #10 - no final Scabies result in the EMR for testing date 11/11/2019 h. Patient #20 - no final histopathology result in the EMR for testing date 1/13/2020 2. When queried on 5/04/2021 at 10:30 am, the LL stated the patient did not return for their follow-up visit in which results are logged into the EMR system. 3. An interview on 5/04/2021 at 10:30 am, the LL confirmed the final patient test results for the testing listed above were not available in the EMR system for the surveyor to review on the day of the survey. 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 --

Summary Statement of Deficiencies D5429 MAINTENANCE AND FUNCTION CHECKS CFR(s): 493.1254(a)(1) For unmodified manufacturer's equipment, instruments, or test systems, the laboratory must perform and document maintenance as defined by the manufacturer and with at least the frequency specified by the manufacturer. This STANDARD is not met as evidenced by: . Based on record review, lack of documentation, and interview with the laboratory director, the laboratory failed to perform and document the monthly maintenance for the microscope for two (2017 and 2018) of two years. Findings include: 1. Record review of the "Microscope Ocular Stage Cleaning Monthly Log" revealed there was no documentation on the log to show that the microscope was cleaned monthly in 2017 and 2018. 2. During the interview on February 4, 2019 at 11:56 AM, the laboratory director stated 'it must have been overlooked" and 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 --