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Get Laboratory Exemption Application - Nevada State Health Division - Health Nv

ICATION & CHECKLIST Exempt Laboratories are a physician s private practice in which tests are collected or performed by the physician, the partners, associates or qualified personnel of the private practice. An Exempt Laboratory can also be an Outpatient Center of a Laboratory. THIS BOX FOR OFFICAL USE ONLY Page 1 of 5 COMPLETE THIS FORM. PLEASE FILL IN THIS FORM ELECTRONICALLY, PRINT, SIGN, DATE AND SUBMIT. (If unable to complete electronically type or print in black or blue ink and submit).

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