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 a review of a facility change of address letter dated 11/13/18, review of 2017-2018 patient test reports and an interview with the lab lead tech, the laboratory failed to identify the address of the laboratory location on five of five test reports where laboratory tests were performed. Findings include: 1. Review of a facility change of address letter signed by the current lab director revealed UT Erlanger Oncology Hematology East, CLIA 44D2096923 at 1751 Gunbarrel Road Suite 101 until there move on 11/13/18 to the current address of 1635 Gunbarrel Road Suite 300, Chattanooga, TN 37421. 2. Review of patient test reports revealed 5 of 5 reports (4/3/17, 6/1/17, 9/11/17, 11/10/17, and 2/19/18) missing the address for laboratory location where testing were performed at 1751 Gunbarrel Road Suite 101. 3. In an interview, on March 20, 2019, at approximately 10:30am, the lab lead tech stated that the five laboratory reports did not include the address of the testing location for 2017- 2018. D6075 TESTING PERSONNEL RESPONSIBILITIES CFR(s): 493.1425(b)(6) Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 2 -- Each individual performing moderate complexity testing must document all