Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391

Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 530025 (X3) Date Survey Completed 11/03/2011
Name of Provider or Supplier Ivinson Memorial Hospital Street Address, City, State 255 N 30th, Laramie, WY
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
A0000 The following abbreviations and acronyms are used throughout this report; less common abbreviations are cited in the text: RN: registered nurse Glucometer: a point-of-care device for monitoring whole blood glucose HIM: Health Information Management CDC: Centers of Disease Control and Prevention; a source of nationally recognized standards and recommended guidelines for infection control