Facility Number:

Hospital Owner/Licensee:

City:

Address:

Facility Name:

Year of Reporting:

Contact 1 e-mail Address:

Contact 2 e-mail Address:

Contact 3 e-mail Address::

Name of Submitter:

Submission Date:

12460

St. Mary's Medical Center San Francisco

450 Stanyan Street

San Francisco

St. Mary's Medical Center San Francisco

2012

Robert Omens

1/8/2013 9:03:02 AM

## Provide the Hospital Owner and Year of Report per Section 130061(e)

12460

2012

St. Mary's Medical Center San Francisco

San Francisco

Page:1 of 13

Report Year:

Report Status:

1/9/2013 6:25 AM

Data Last Update:

09/17/2012

Submission Date:

01/08/2013

Print Date:

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For buildings For buildings which are planned for rebuild, retrofit or replacement this report shall identify;  Whether the hospital owner intends to rebuild, retrofit or replace the building to SPC2, SPC3, SPC4 or SPC5 per 130061(c)(1)(A). The deadline, as described in Section 130060 or 130061.5,for rebuild, retrofit or replacement of the building that the hospital owner intends to meet, and the applicable extension for which the hospital owner has been approved per Section 130061(c)(1)(B)

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Report Status:

1/9/2013 6:25 AM

Data Last Update:

09/17/2012

Submission Date:

01/08/2013

Print Date:

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Report Status:

1/9/2013 6:25 AM

Data Last Update:

Submission Date:

01/08/2013

2012

12460

- St. Mary's Medical Center San Francisco

San Francisco

Provide the number of inpaient beds and patient days per type of service per building per Section 130061(c)(1)(F)

BLD-01073

McAuley Wing

- [ ] Nursing

Building Number:

Building Name:

- [ ] IntensiveCare

- [x] X Psychiatric Nursing

- [ ] Pediatric/Adol escent

- [ ] Obstetrical Ante/Postprtum

- [ ] Intermediate Care

- [ ] Skilled Nursing

- [x] X Clinical Lab

- [x] X Emergency

- [x] X Pharmaceutical

- [x] X Dietetic

- [x] X Administration

- [x] X Central Plant

22

- [ ] 0

- [x] 0 Inpatient Days

## Type of Service Provided

Inpatient Beds

Inpatient Beds

Inpatient Beds

Inpatient Beds

Inpatient Beds

Inpatient Beds

Inpatient Beds

- [x] 0 Inpatient Days 0

- [x] 0 Inpatient Days 0

- [x] 22 Inpatient Days 2753

0 Inpatient Days 0

- [x] 0 Inpatient Days 0

0 Inpatient Days 0

Total Beds this Building

- [ ] Surgical

- [ ] Obstetrical Recovery

- [ ] Anesthesia

- [ ] Newborn/ WellBaby

- [ ] Support Services

- [ ] Radiological/ Imaging

- [ ] Outpatient Surgery

- [ ] Nuclear Medicine

- [ ] Rehabilitation Therapy

- [ ] Renal Dialysis

- [ ] Obstetrical Cesarean/Deliv

Report Status:

1/9/2013 6:25 AM

Data Last Update:

09/17/2012

Submission Date:

01/08/2013

Print Date:

2012

12460

San Francisco

Building Number:

Building Name:

Pediatric

Perinatal (excluse Newborn / GYN)

Medical / Surgical (Include GYN)

Intermediate Card

Coronary Care

Intensive Care

Rehabilitation Center

Chemical Dependency

Acute Respiratory Care

Skilled Nursing

Burn

intensive Care Newborn Nursery

Acute Psychiatric

Int. Care / development Disabled

Total Beds this Building Per Unit

Total Beds this Building Per Service

Inpatient Bed 0

- [ ] Inpatient Days 0

- [ ] Inpatient Days 0

Inpatient Bed 0

- [ ] Inpatient Days 0

Inpatient Bed

Inpatient Days

Inpatient Bed 0

- [ ] Inpatient Days 0

Inpatient Bed

- [ ] Inpatient Days 0

- [ ] Inpatient Bed 0

Inpatient Days

Inpatient Bed

- [ ] Inpatient Days 0

- [ ] Inpatient Bed 0

- [ ] Inpatient 0

Days

- [ ] Inpatient Bed 0

- [ ] Inpatient Days 0

Inpatient Bed

- [ ] Inpatient Days 0

Inpatient Bed

- [ ] Inpatient Days 0

Inpatient Bed

Inpatient Days

Inpatient Bed 0

Inpatient Days

Inpatient Bed

BLD-01073

McAuley Wing

0

0

0

- [ ] 0

- [ ] 0

0

22

22

22

2753

0

0

0

Provide the number of Inpatient beds and patient days per type of unit per building per Section 130061(c)(1)(F)

Report Status:

<!-- image -->

1/9/2013 6:25 AM

<!-- image -->

1/9/2013 6:25 AM

Print Date:

Building Number:

Building Name:

- [ ] Nursing

- [ ] IntensiveCare

- [ ] Pediatric/Adol escent

- [x] Psychiatric Nursing X

- [ ] Obstetrical Ante/Postprtum

- [ ] Intermediate Care

- [ ] Skilled Nursing

BLD-01073

McAuley Wing

Type of Service Provided

- [ ] Surgical

- [ ] Anesthesia

- [ ] Support Services

- [x] Administration X

- [x] Dietetic X

- [x] Pharmaceutical X

- [x] Clinical Lab X

- [ ] Radiological/ Imaging

- [ ] Outpatient Surgery

- [x] Central Plant X

- [ ] Rehabilitation Therapy

- [ ] Renal Dialysis

- [x] X Emergency

- [ ] Obstetrical Cesarean/Deliv

- [ ] Obstetrical Recovery

- [ ] Newborn/ WellBaby

- [ ] Nuclear Medicine

Report any general acute care hospital inpatient service that is provided in any genaral acute care hospital building that is rated SPC-1 per Section 130061(c)(4)

12460

2012

- St. Mary's Medical Center San Francisco

San Francisco

Page:8 of 13

Report Year:

Report Status:

Data Last Update:

1/9/2013 6:25 AM

Submission Date:

01/08/2013

Print Date:

Report Year:

12460

2012

San Francisco

Report the final configuration of all buildings on the hospital campus showing how each building will comply with the SPC-5/NPC-4 or 5 requirements whether by retrofit or by replacement and the type of service that will be provided in each general actue care hospital building per Section 130061(c)(5)

- [x] Nursing X

- [x] IntensiveCare X

- [ ] Pediatric/Adol escent

- [x] Psychiatric Nursing X

- [ ] Obstetrical Ante/Postprtum

- [ ] Intermediate Care

- [x] Skilled Nursing X

- [x] Support Services X

- [x] Administration X

- [x] Dietetic X

- [x] Pharmaceutical X

- [x] Radiological/ Imaging X

- [x] Clinical Lab X

- [x] Anesthesia X

- [x] Surgical X

- [ ] Obstetrical Recovery

- [ ] Newborn/ WellBaby

- [x] Emergency X

- [x] Nuclear Medicine X

- [x] Rehabilitation Therapy X

- [x] Renal Dialysis X

- [x] Outpatient Surgery X

- [x] Central Plant X

- [ ] Obstetrical Cesarean/Deliv

Building Number:

Type of Service Provided

Building Name:

BLD-01072

Main Tower

Remove from GAC service by 1/1/2030

Configuration:

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Report Status:

1/9/2013 6:25 AM

Data Last Update:

09/17/2012

Submission Date:

01/08/2013

Print Date:

Report Year:

12460

2012

- St. Mary's Medical Center San Francisco

San Francisco

Page:10 of 13

- [ ] Nursing

- [ ] IntensiveCare

- [ ] Pediatric/Adol escent

- [x] Psychiatric Nursing X

- [ ] Obstetrical Ante/Postprtum

- [ ] Intermediate Care

- [ ] Skilled Nursing

- [ ] Support Services

- [x] Administration X

- [x] Dietetic X

- [x] Pharmaceutical X

- [ ] Radiological/ Imaging

- [x] Clinical Lab X

- [ ] Anesthesia

- [ ] Surgical

- [ ] Obstetrical Recovery

- [ ] Newborn/ WellBaby

- [x] Emergency X

- [ ] Nuclear Medicine

- [ ] Rehabilitation Therapy

- [ ] Renal Dialysis

- [ ] Outpatient Surgery

- [x] Central Plant X

- [ ] Obstetrical Cesarean/Deliv

Building Number:

Type of Service Provided

Building Name:

BLD-01073

McAuley Wing

Remove from GAC service by 1/1/2030

Configuration:

Report the final configuration of all buildings on the hospital campus showing how each building will comply with the SPC-5/NPC-4 or 5 requirements whether by retrofit or by replacement and the type of service that will be provided in each general actue care hospital building per Section 130061(c)(5)

Report Status:

1/9/2013 6:25 AM

Data Last Update:

09/17/2012

Submission Date:

01/08/2013

Print Date:

12460

2012

- St. Mary's Medical Center San Francisco

San Francisco

Page:11 of 13

Report Year:

Include information on the number of inpatient beds by type of Service provided by buildings that are classified as SPC-2, SPC-3, SPC-4, and SPC-5 per Section 130061(e)

BLD-01072

Main Tower

- [x] X Nursing

- [x] X IntensiveCare

Building Number:

Building Name:

- [x] X Psychiatric Nursing

- [x] X Skilled Nursing

- [ ] Pediatric/Adol escent

- [ ] Obstetrical Ante/Postprtum

- [ ] Intermediate Care

- [x] X Surgical

- [x] X Anesthesia

- [x] X Clinical Lab

- [x] X Emergency

- [x] X Radiological/ Imaging

- [x] X Nuclear Medicine

- [x] X Pharmaceutical

- [x] X Rehabilitation Therapy

- [x] X Dietetic

- [x] X Renal Dialysis

- [x] X Administration

- [x] X Outpatient Surgery

- [x] X Support Services

- [x] X Central Plant

381

299

## Type of Service Provided

Inpatient Beds

Inpatient Beds

Inpatient Beds

Inpatient Beds

Inpatient

Beds

Inpatient Beds

Inpatient Beds

37

0

13

0

32

0

Total Beds this Building

- [ ] Obstetrical Cesarean/Deliv

- [ ] Obstetrical Recovery

- [ ] Newborn/ WellBaby

Report Status:

Data Last Update:

1/9/2013 6:25 AM

Submission Date:

01/08/2013

Print Date:

Report Year:

12460

2012

- St. Mary's Medical Center San Francisco

San Francisco

Include information on the number of inpatient beds by type of unit provided by buildings that are classified as SPC-2, SPC-3, SPC-4, and SPC-5 per Section 130061(e)

Building Number:

Building Name:

Pediatric

Perinatal (excluse Newborn / GYN)

Medical / Surgical (Include GYN)

Intermediate Card

Coronary Care

Intensive Care

Rehabilitation Center

Chemical Dependency

Acute Respiratory Care

Skilled Nursing

Burn

intensive Care Newborn Nursery

Acute Psychiatric

Int. Care / development Disabled

Total Beds this Building Per Unit

Total Beds this Building Per Service

Inpatient Bed

Inpatient Days

Inpatient Days

Inpatient Bed

Inpatient Days

Inpatient Bed

Inpatient Days

Inpatient Bed

Inpatient Days

Inpatient Bed

Inpatient Days

Inpatient Bed

Inpatient Days

Inpatient Bed

Inpatient Days

Inpatient Bed

Inpatient Days

Inpatient Bed

Inpatient Days

Inpatient Bed

Inpatient Days

Inpatient Bed

Inpatient Days

Inpatient Bed

Inpatient Days

Inpatient Bed

Inpatient

Days

Inpatient Bed

BLD-01072

Main Tower

263

18790

- [ ] 0

0

0

0

37

3377

0

0

0

- [ ] 0

- [ ] 0

- [ ] 0

- [ ] 0

0

36

5173

0

- [ ] 0

381

381

- [ ] 13

0

- [ ] 32

7478

- [ ] 0

- [ ] 0

0

0

Report Status:

Data Last Update:

1/9/2013 6:25 AM

Submission Date:

01/08/2013

Print Date:

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