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: 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) Report Status: 1/9/2013 6:25 AM Data Last Update: 09/17/2012 Submission Date: 01/08/2013 Print Date: 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: 1/9/2013 6:25 AM 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: 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: