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  • Disclosure Of Ownership Form Texas Clia

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Address (number, street) City CLIA number Taxpayer ID number (EIN) State ZIP code Telephone number ( ) II. Answer the following questions by checking Yes or No. If any of the questions are answered Yes, list names and addresses of individuals or corporations under Remarks on page 2. Identify each item number to be continued. YES NO A. Are there any individuals or organizations having a direct or indirect ownership or control interest of five percent or mor.

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CLIA regulatory requirements classify testing into three categories: high complexity, moderate complexity and waived.

The Texas Health and Human Services Commission (HHSC), on behalf of the CMS CLIA program, uses Form 3225 to process CLIA certificate applications. Applicants must forward a completed Form 3225 to their appropriate CLIA State Agency regional office for HHSC to accept and process their CLIA application.

All laboratory results for patients tested in Texas must be reported to DSHS. Additionally, any results for Texas residents (home address listed as Texas) who are tested outside of Texas must also be reported to DSHS.

For CLIA-related questions please contact: Email: LabExcellence@cms.hhs.gov. Phone Line: 404-498-2290 (Voice mail)

The Clinical Laboratory Improvement Amendments (CLIA) regulate laboratory testing and require clinical laboratories to be certified by the Center for Medicare and Medicaid Services (CMS) before they can accept human samples for diagnostic testing.

Be certified by an HHS-approved board. Have two years of lab training or experience.

CLIA applies to all entities providing clinical lab services and requires these labs meet applicable federal requirements and have a current CLIA certificate, including those that don't file Medicare test claims. CLIA requirements also apply to labs in physician offices.

The Texas Health and Human Services Commission (HHSC), on behalf of the CMS CLIA program, uses Form 3225 to process CLIA certificate applications. Applicants must forward a completed Form 3225 to their appropriate CLIA State Agency regional office for HHSC to accept and process their CLIA application.

In general terms, the CLIA regulations establish quality standards for laboratory testing performed on specimens from humans, such as blood, body fluid and tissue, for the purpose of diagnosis, prevention, or treatment of disease, or assessment of health.

The Clinical Laboratory Improvement Amendments (CLIA) regulate laboratory testing and require clinical laboratories to be certified by the Center for Medicare and Medicaid Services (CMS) before they can accept human samples for diagnostic testing.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232