Wayne Family Medicine

CLIA Laboratory Citation Details

1
Total Citation
3
Total Deficiencyies
2
Unique D-Tags
CMS Certification Number 28D0455701
Address 615 East 14th Street, Wayne, NE, 68787
City Wayne
State NE
Zip Code68787
Phone402 375-2500
Lab DirectorKIMBERLY RUSK

Citation History (1 survey)

Survey - September 13, 2024

Survey Type: Standard

Survey Event ID: PJ7Y11

Deficiency Tags: D6063 D6065 D6065

Summary:

Summary Statement of Deficiencies D6063 LABORATORY TESTING PERSONNEL CFR(s): 493.1421 The laboratory must have a sufficient number of individuals who meet the qualification requirements of 493.1423, to perform the functions specified in 493. 1425 for the volume and complexity of tests performed. This CONDITION is not met as evidenced by: Based on lack of documentation the laboratory failed to have proof of education on one out of seven moderate complexity testing personnel, as listed on the CMS-209. Refer to D6065. D6065 TESTING PERSONNEL QUALIFICATIONS CFR(s): 493.1423(b)(1)(2)(3)(4)(i) (b) Meet one of the following requirements: (b)(1) Be a doctor of medicine or doctor of osteopathy licensed to practice medicine or osteopathy in the State in which the laboratory is located or have earned a doctoral, master's, or bachelor's degree in a chemical, physical, biological or clinical laboratory science, or medical technology from an accredited institution; or (b)(2) Have earned an associate degree in a chemical, physical or biological science or medical laboratory technology from an accredited institution; or (b)(3) Be a high school graduate or equivalent and have successfully completed an official military medical laboratory procedures course of at least 50 weeks duration and have held the military enlisted occupational specialty of Medical Laboratory Specialist (Laboratory Technician); or (b)(4)(i) Have earned a high school diploma or equivalent; and This STANDARD is not met as evidenced by: Based on lack of documentation and interview with the laboratory director, the 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 -- laboratory failed to have proof of education on one out of seven testing personnel listed on the CMS-209. Findings are: 1. No proof of education documentation for testing personnel #7, as listed on the CMS-209, performing moderate complexity testing was presented at time of survey. 2. Interview with the laboratory director on 9 /13/2023 at 1:30 PM, confirmed no documentation was available. -- 2 of 2 --

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