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 01P001 (X3) Date Survey Completed 03/03/2022
Name of Provider or Supplier Legacy Of Hope Street Address, City, State 516 20th Street South, Birmingham, AL
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)
Z0000 An unannounced Organ Procurement Organization (OPO) Recertification Survey was conducted on-site at Legacy of Hope OPO on February 28 - March 3, 2022. Legacy of Hope was not in substantial compliance with Medicare Regulations at 42 CFR Part 486 - Conditions for Coverage: Organ Procurement Organizations. The OPO was out of compliance at the following Standard Level: Z175, Potential Donor Evaluation.