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 review of patient reports for testing performed by the laboratory and its reference laboratory (Neshoba County General Hospital) and interview with Testing Personnel #1, listed on the Centers for Medicare and Medicaid Services (CMS) 209 personnel form, on 2-6-20 at 10:30 a.m., five of eight test reports reviewed did not include the address and/or name of the laboratory location where the testing was performed. Findings include: Review of test reports from electronic medical records for eight patients revealed three of the test reports did not include the laboratory address where the testing was performed and two of the test reports did not include the correct laboratory name and address where the testing was performed. 1. The following test reports did not include the address of the performing location (Neshoba Medical Associates): Hematology Reports for Patient Encounters #6120621, #6118758, and #6124113. 2. The following test reports did not include the correct name and address of the performing location: Routine Chemistry and Lipids for Patient Encounters #6120419 and #6123975. In an interview on 2-6-20 at 10:30 a.m., Testing Personnel #1 stated these Routine Chemistry and Lipid tests were performed at Neshoba County General Hospital, even though the heading on the test report has the name and address of Neshoba Medical Associates. 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 --