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Deficiency - 165 - PE Report/ PFT Facility not Provided

Explanation: PE Report/ PFT Facility not Provided

Instructions: The PFT results referenced within the physical exam report/medical records review does not provide the name of the facility that performed the PFTs. In order to resolve this deficiency, please submit a complete qualifying PFT report (with all trails and tracings) that identifies the name of the facility, or submit a signed PFT Facility Verification affidavit, which can be found on the Trust’s website, verifying that the PFTs were not performed at a facility deemed unacceptable by the Trust.

Detail Text: The PFT results referenced within the physical exam report/medical records review does not provide the name of the facility that performed the PFTs. In order to resolve this deficiency, please submit a complete qualifying PFT report (with all trails and tracings) that identifies the name of the facility, or submit a signed PFT Facility Verification affidavit, which can be found on the Trust’s website, verifying that the PFTs were not performed at a facility deemed unacceptable by the Trust.

Option: BOTH

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