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 record review and staff interview the laboratory failed to indicate the name and the address of the laboratory where the hematology tests were performed. Findings include: 1. Record review of two patient final reports on 8/7/19 from the laboratory information system (LIS) revealed the reports did not indicate the name and the address of the laboratory where the complete blood count (CBC) tests were performed. The LIS reports for CBC's indicated only the name and the address of the hospital main laboratory. 2. Record review on 8/7/19 of the electronic medical records (Epic) for the above patients revealed incorrect testing location was listed for the CBC tests. 3. Staff interview with testing personnel #1 on 8/7/19 at 11:30 AM confirmed the above findings. 4. Laboratory performs approximately 6,192 CBC tests 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 --