On July 12, 2018, the NRC issued a Notice of Violation to Missouri Baptist Medical Center for a Severity Level III violation for failure to implement 10 CFR 35.41(a) requirements. The violation involved the licensee's failure to develop, implement, and maintain procedures to provide high confidence that an administration requiring a written directive was performed in accordance with the written directive. Specifically, as of January 29, 2018, the licensee's procedures for administrations using a high dose-rate remote after-loader (HDR) unit did not include a verification that the treatment plan would deliver the dose specified by the written directive.