| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 670097 | (X3) Date Survey Completed 08/16/2016 |
| Name of Provider or Supplier Baylor Emergency Medical Center | Street Address, City, State 1975 Alpha Ste 100, Rockwall, TX | |
| 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 | Note: The CMS-2567 (Statement of deficiencies) is an official, legal document. All information must remain unchanged except for entering the plan of correction, correction dates, and the signature space. Any discrepancy in the original deficiency citation (s) will be referred to the Dallas Regional Office (RO) for referral to the office of the Inspector General (OIG) for possible fraud. If information is inadvertently changed by the provider/supplier, the State Survey Agency (SA) should be notified immediately. An on-site unannounced complaint survey was conducted from 08/15-16/2016. An entrance conference was held in a conference room with the Administrative staff members. The purpose and process of the survey was explained and an opportunity was given for questions and discussion. An exit conference was held on 08/16/2016 with administrative staff members. The preliminary findings of the survey were explained. An opportunity was provided for the facility to provide evidence of compliance with those requirements for which non-compliance had been found during the survey. No such evidence was either alleged or provided. Complaint TX 00242642 was investigated during the survey. The facility was found to be out of compliance with the following Conditions of Participation: CFR 482.55 Emergency Services. Acronyms and terms used are as follows: Ballotable- meaning when put gentle pressure on it, it floats away. C/O- complaints of Dr.- Doctor EMS- Emergency medical service EMT- Emergency medical technician Introitus- an entrance that goes into a canal or hollow organ. FHT/fth- Fetal heart tone L&D- Labor and delivery MD- Medical doctor POC- Plan of care PT/pt- Patient RN- Registered nurse Rovsing's sign- sign of appendicitis |