If a patient specifically requests that no lay summary be sent to her, the facility may comply with the patient's request provided the facility adequately documents why it did not comply with the requirement in section 900.12(c)(2) to provide a lay summary. We recommend that the facility take all of the following actions: 1. Obtain from the patient a signed written statement indicating that she does not want to receive her lay summary. The facility should obtain from the patient a separate statement for each examination for which the patient says she does not want to receive a lay summary. 2. Maintain the patient’s signed written statement(s) until the facility’s next annual MQSA inspection. 3. Have the patient designate someone to receive the lay summary on her behalf, such as her physician or another responsible party.