On June 8, 2011, the NRC issued a Notice of Violation to Mercy Hospital for a Severity Level III violation involving the failure to develop, implement, and maintain written procedures to provide high confidence that each administration is in accordance with the written directive as required by 10 CFR 35.41(a). Specifically, between June 18, 2008 and February 23, 2011, the licensee performed approximately 200 high dose-rate (HDR) remote afterloader administrations requiring written directives, and failed to develop written procedures to provide high confidence that each administration was in accordance with the written directive.