Pauls Valley General Hospital

Summary Statement of Deficiencies D0000 RECERTIFICATION SURVEY Immediate Jeopardy was determined during the survey performed on 11/13/17-11/16/17 due to issues identified with Immunohematology testing. The findings were reviewed with the laboratory manager during an exit conference performed at the conclusion of the survey. The laboratory was found out of compliance with the following CLIA regulations: 1. 493.1215: D5024: Hematology 2. 493.1217: D5026: Immunohematology 3. 493.1250: D5400: Analytic Systems 4. 493.1403: D6000: Laboratory Director, Moderate Complexity 5. 493.1409: D6033: Technical Consultant 6. 493.1421: D6063: Testing Personnel, Moderate Complexity 7. 493.1441: D6076: Laboratory Director, High Complexity 8. 493.1447: D6108: Technical Supervisor 9. 493.1487: D6168: Testing Personnel, High Complexity *************************************************** REVISIT SURVEY The Immediate Jeopardy had been abated prior to the revisit survey performed on 04/02/18. The laboratory was found out of compliance with the following CLIA regulations: 1. 493.1217: D5026: Immunohematology 2. 493.1250: D5400: Analytic Systems 3. 493.1403: D6000: Laboratory Director, Moderate Complexity 4. 493.1409: D6033: Technical Consultant 5. 493.1441: D6076: Laboratory Director, High Complexity 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 --