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 11/07/2011
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)
K0000


This STANDARD is not met as evidenced by:
Requirements for Hospitals Section 42 CFR 482.41 (b) except as otherwise provided in this section, the facility must meet the applicable provisions of the 2000 edition of the Life Safety Code, Existing Business Occupancy, of the National Fire Protection Association (NFPA). The facility was a fully sprinkled two story building of Type II (111) construction with plan approval in 1998. The building was equipped with a supervised automatic wet sprinkler system and a pre-action system with an addressable fire alarm system.