Summary:
Summary Statement of Deficiencies D5805 TEST REPORT CFR(s): 493.1291(c) (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 upon a review of 15 final reports and interviews with laboratory staff, the laboratory test report failed to include the name and address of Unity Health Lab of Path CLIA # 04D2122809 (the laboratory where testing was performed) for 15 of 15 reports reviewed. Survey findings include: A) Review of seven surgical pathology final reports did not have the name of the laboratory where the testing was performed ( Unity Health Lab of Path CLIA # 04D2122809) but had the address of a seconf laboratory at 1430 West C Street in Russellville, AR 72801. B) Review of two oral pathology final reports did not have the name of the laboratory where the testing was performed ( Unity Health Lab of Path CLIA # 04D2122809) but had the address of a seconf laboratory at 1430 West C Street in Russellville, AR 72801. C) Review of three non-gynecological cytology final reports did not have the name of the laboratory where the testing was performed (Unity Health Lab of Path CLIA # 04D2122809) but had the address of a second laboratory at 1430 West C Street in Russellville, AR 72801. D) Review of three gynecological cytology final reports did not have the name of the laboratory where the testing was performed (Unity Health Lab of Path CLIA # 04D2122809) but had the address of a second laboratory at 1430 West C Street in Russellville, AR 72801. E) In an interview, at 11:10 a.m.on 10/9/25, the laboratory 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 -- staff member (# 1 as listed on the form CMS-209) confirmed the final pathology reports identified above were performed and reported from Unity Health Lab of Path (04D2122809) located at 1200 South Main St. in Searcy, AR 72143 and the reports did not include the name of the laboratory where the testing was performed. -- 2 of 2 --