Summary:
Summary Statement of Deficiencies D0000 The recertification survey was performed on 09/22/2021. The findings were reviewed with the histotechnician at the conclusion of the survey. The laboratory was found in compliance with a standard-level deficiency cited. 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 a review of patient test reports and interview with the histotechnician, the laboratory failed to ensure test reports included the address of the laboratory for 3 of 6 reports. Findings include: (1) On 09/22/2021, the surveyor reviewed 6 patient test reports and identified that 3 reports did not include the address of the laboratory: (a) Report #1 - A Mohs procedure was performed with the results reported on 09/01 /2020: (b) Report #2 - A Mohs procedure was performed with the results reported on 09/01/2020: (c) Report #3 - A Mohs procedure was performed with the results reported on 01/19/2021. (2) The surveyor reviewed the reports with the histotechnician. The histotechnician stated on 09/22/2021 at 12:40 pm the 3 patient reports did not include the address of the laboratory as indicated above. 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 --