Methodist Southlake Medical Center

CLIA Laboratory Citation Details

1
Total Citation
52
Total Deficiencyies
52
Unique D-Tags
CMS Certification Number 45D2057557
Address 421 E State Highway 114-1st Floor, Southlake, TX
City Southlake
State TX

Citation History (1 survey)

Survey - May 8, 2018

Survey Type: Standard

Survey Event ID: NBJ212

Deficiency Tags: D0000 D2009 D2016 D2121 D3025 D5400 D5401 D5403 D5411 D5415 D5441 D5447 D5537 D5783 D5791 D6021 D6023 D6031 D6036 D6042 D6063 D6065 D6168 D6171 D2007 D2010 D2017 D2130 D3031 D3037 D5209 D5217 D5311 D5417 D5421 D5429 D5437 D5445 D5469 D5779 D5785 D5793 D5891 D6000 D6007 D6013 D6016 D6020 D6025 D6033 D6040 D6044

Summary:

Summary Statement of Deficiencies D0000 An unannounced onsite revisit was conducted 05/08/2018. This facility was found to remain NOT in compliance with the CLIA conditions for specialties/subspecialties surveyed for 42 CFR 493.1250 Analytic systems 493.1403 Moderate complexity laboratory director 493.1409 Technical consultant moderate complexity -------------------------------------------------------------------------- An entrance conference was held 09/11/2017 with the Technical Consultant, Testing Person #3, Quality/Risk Manager, and Director of Radiology. The survey process was discussed. An opportunity for questions and comments was given. Based upon the survey conducted 09/11/2017 through 09/14/2017, this facility was found to be NOT in compliance with the CLIA conditions for specialties/subspecialties surveyed for 42 CFR 493.803 Successful participation 493.807 Reinstatement of nonwaived laboratories 493.1250 Analytic systems 493.1403 Moderate complexity laboratory director 493.1409 Technical consultant moderate complexity 493.1421 Laboratory testing personnel 493.1487 Testing personnel An exit conference was held on 09/14/2017 with the Technical Consultant and Director of Radiology. The exit conference attendee was advised the laboratory was out of compliance and advised of conditions and deficiencies found during the survey. An opportunity for questions and comments was provided. 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 --

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