Get Doh 4081ms

The Doh 4081ms form allows for the registration of a limited service laboratory and the addition of a permanent testing location to a multi-site network application. This guide will provide step-by-step instructions to help users complete this document accurately and efficiently online.

Follow the steps to complete the Doh 4081ms online.

1. Click ‘Get Form’ button to access the form and open it in the designated online editor.
2. Begin filling out the primary laboratory information. This section requires you to enter the CLIA number, laboratory name (limited to 70 characters), PFI number, and the complete physical address of the primary laboratory, including city, state, telephone number, and email address.
3. In the additional testing site information section, provide details about the new permanent limited service laboratory location you want to add. Enter the site name (also limited to 70 characters), county/borough, site address, and contact details including telephone number and email address.
4. Indicate the testing days and hours for the new site. Clearly clarify hours in AM/PM format for each day of the week.
5. Mark all waived test procedures you intend to perform from the provided list and estimate the annual test volume for each procedure you checked.
6. Check off all provider-performed microscopy procedures you intend to perform and estimate the annual test volume for these procedures as well.
7. Review the certification section. By signing this application, you are agreeing to the responsibilities and regulations outlined. Ensure that all provided information is accurate before proceeding.
8. Complete the signature fields at the bottom of the form. This includes the printed names and signatures of both the laboratory director and the person completing the form, along with the respective dates.
9. Once you have filled out all necessary fields and sections, save your changes. You can then download, print, or share the completed document as needed.

Start completing your Doh 4081ms form online today for a seamless application process.