Get Laboratory Registration Fom Form

Completing the Laboratory Registration Form online is a straightforward process that helps ensure compliance with CLIA regulations. This guide provides step-by-step instructions to assist users in accurately filling out the form and submitting it promptly.

Follow the steps to complete the Laboratory Registration Form online.

1. Click ‘Get Form’ button to access the Laboratory Registration Form and open it in your preferred document editor.
2. Begin by filling in the name of your facility. Ensure that the name is clear and matches the legal entity name registered with relevant authorities.
3. Provide a valid telephone number where the laboratory can be reached for any inquiries.
4. Enter the physical address of the laboratory, including city, state, and zip code. If your mailing address differs, fill that in as well.
5. Input the name of the Laboratory Director. This individual must meet the qualifications set by CLIA regulations.
6. Name the Contact Person who is knowledgeable about the laboratory’s operations and should be contacted for any questions.
7. If applicable, fill in the details for the Technical Consultant/Supervisor. This position is only required for laboratories holding full certificates.
8. Indicate the number and types of testing personnel under the specified categories (e.g., MT, MLT, RN). Ensure accuracy in these counts.
9. Provide the name of the Clinical Consultant, who must be a qualified MD or DO under CLIA guidelines.
10. Select the appropriate Level of CLIA Certificate by checking the relevant box. This should align with the tests you intend to perform.
11. Complete the section on the back of the form regarding the types of tests performed in your lab. Be thorough and include any special kits or instruments used.
12. Review your entries for accuracy and completeness. Retain a copy of the form for your records.
13. Once finalized, save the changes, download the completed form, and print or share it as necessary.

Start filling out your Laboratory Registration Form online today to ensure compliance and proper registration.