White House Pain Institute Llc

CLIA Laboratory Citation Details

1
Total Citation
1
Total Deficiency
1
Unique D-Tag
CMS Certification Number 44D2067584
Address 491 Sage Rd Ste 1100, White House, TN, 37188
City White House
State TN
Zip Code37188
Phone(615) 672-5575

Citation History (1 survey)

Survey - June 19, 2018

Survey Type: Complaint

Survey Event ID: MMS511

Deficiency Tags: D1001

Summary:

Summary Statement of Deficiencies D1001 CERTIFICATE OF WAIVER TESTS CFR(s): 493.15(e) Laboratories eligible for a certificate of waiver must-- (1) Follow manufacturers' instructions for performing the test; and (2) Meet the requirements in subpart B, Certificate of Waiver, of this part. This STANDARD is not met as evidenced by: Based on review of the manufacturers package insert for urine drug screen testing cup, observation of the testing personnel (TP) and interview with the office manager determined that the laboratory failed to follow manufacture package insert for timing the urine drug test. The findings include: 1. Review of the manufacturers package insert for urine drug screen testing cup states "wait 5 minutes to determine a positive result" the laboratory failed to follow manufacturers package insert instructions by not using a timer. 2. Observation of the TP determined that the TP did not following the manufacturers package insert instructions for urine drug screen testing by not using a timer before resulting patient results. 3. Interview with the office manager on June 21, 2018 at 11:30 confirmed that the laboratory failed to follow manufacturers package insert instructions for timing urine drug screens. 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 --

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