Get Maryland Tissue Bank Application - Dhmh - Dhmh Md

Completing the Maryland Tissue Bank Application online is an essential step for any tissue bank seeking to operate in Maryland. This guide will provide a thorough overview of the application process, ensuring you fill out each section accurately and efficiently.

Follow the steps to complete your application correctly.

1. Click the ‘Get Form’ button to obtain the application form and open it for editing.
2. In the I. Tissue Bank Information section, fill out the name of the tissue bank, the director's name, site information, ownership details, tissue type, state permit number, address, and contact information, ensuring all fields are complete.
3. Proceed to II. Medical Director Information section. Enter the medical director's name, degree, work status (full-time/part-time), certification details, and state medical license number.
4. In III. Technical Director Information, fill out the name and degree of the technical director, specifying whether they are full-time or part-time, and include their certification and work hours.
5. For IV. Ownership Information, list the names and addresses of individuals or organizations with ownership interests (greater than 5%), and include the EIN for organizations. Use a separate sheet if needed.
6. In V. Accreditation Information, indicate if your laboratory is accredited and provide the name of the accrediting organization and the last on-site survey date if applicable.
7. Fill in VI. Tissue Types by checking all applicable tissue categories associated with your tissue bank. Ensure to mention any additional types and answer whether laboratory testing is performed.
8. Lastly, in VI. Attestation, ensure the medical director's signature is included, certifying the information's accuracy. Record the date of signing.
9. After providing all necessary information, review your application for completeness, save your changes, and prepare to download, print, or share the completed form as required.

Take the necessary steps and complete your Maryland Tissue Bank Application online today to ensure timely processing.