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  • Cms-116 2014

Get Cms-116 2014

Ian Office Is this a shared lab? Yes No 22 Practitioner Other (Specify) ______________________________ 23 Prison 24 Public Health Laboratories 25 Rural Health Clinic 26 School/Student Health Service 27 Skilled Nursing Facility/ Nursing Facility 28 Tissue Bank/Repositories 29 Other (Specify) ______________________________ (List times during which laboratory testing is performed in HH:MM format) If MONDAY TUESDAY WEDNESDAY THURSDAY testing 24/7 Check Here FRIDA.

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How to fill out the CMS-116 online

Filling out the CMS-116 form is a crucial step for laboratories seeking CLIA certification. This guide provides a clear and comprehensive walkthrough to help you complete the form accurately and efficiently.

Follow the steps to successfully complete your CMS-116 application

  1. Click ‘Get Form’ button to obtain the CMS-116 form and open it in your preferred online editor.
  2. In section I, mark the appropriate box to indicate if this is an initial application, a survey, or a change in certificate type. If you are submitting an initial application, leave the CLIA Identification Number blank as it will be assigned later.
  3. Provide the facility name, address, email address, telephone number, and federal tax identification number. Ensure that the physical address includes specific details such as building, floor, and suite.
  4. In section II, choose the type of certificate you are requesting by checking one of the options provided based on the complexity of tests performed in your laboratory.
  5. In section III, select the type of laboratory that best describes your facility from the list provided.
  6. Section IV requires you to indicate the hours during which laboratory testing occurs. Use HH:MM format, and check the box for '24/7' if applicable.
  7. If applying for a single site CLIA certificate to cover multiple locations, complete section V. Ensure to meet the necessary regulatory exceptions.
  8. Sections VI, VII, and VIII focus on the various types of testing your laboratory performs. Provide detailed information on each category of tests, including the estimated annual test volume for waived, PPM, and non-waived testing.
  9. Select the appropriate ownership type in section IX by marking the box that describes your facility's control structure.
  10. In section X, list any additional laboratories for which the director is responsible if applicable.
  11. Finally, review the entire form for accuracy. Once completed, save your changes, and you may choose to download, print, or share the form as needed. Ensure all required sections are filled out completely before submission.

Complete your CMS-116 form online today to ensure your laboratory's compliance with CLIA regulations.

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CMS forms, including the CMS-116, are utilized primarily for the registration and certification of healthcare facilities and services. They help standardize information collection for compliance with federal regulations. Using documents like the CMS-116 ensures that laboratories can operate legally while providing high-quality patient care.

A certificate of waiver allows laboratories to perform specific types of clinical tests that are deemed low-risk, without the need for extensive oversight. This certification streamlines the testing process, making it more accessible for many facilities. By obtaining a certificate of waiver, you can enhance your laboratory services while adhering to necessary regulations.

To obtain a CLIA certification, you must first complete the CMS-116 form accurately and submit it to the Centers for Medicare & Medicaid Services (CMS). After submission, an inspection may follow to ensure your laboratory complies with federal regulations. Utilizing platforms like USLegalForms can simplify this process, offering you guidance and necessary resources to achieve your CLIA certification efficiently.

Filling out the Medicare CMS 1763 form involves entering your name, address, and Medicare number accurately. It’s essential to follow the instructions on the form carefully. After providing all required information, double-check it for errors before submission. This attention to detail helps ensure your request is processed efficiently.

Currently, you cannot submit the CMS 1763 form online. The submission process requires you to print the completed form and send it by mail or deliver it in person to a Social Security office. While it may seem less convenient, this ensures your information is securely processed. It’s important to keep a copy for your records.

To count tests for CLIA certification, you should first know the type of laboratory tests your facility performs. Each test is categorized into specific CLIA complexity levels, such as waived, moderate, or high. The total is measured by the number of different tests performed, not the frequency. Accurate counting is crucial for maintaining compliance and reporting.

Filling out a CMS 1763 form effectively involves providing clear personal details, like your Medicare number and contact information. This form is used to terminate Part B coverage. After completing all required sections, review the information for accuracy. You can then submit the CMS 1763 by mail or at a local Social Security office.

To enroll in or make changes to Medicare Part B, you need to fill out the CMS 116 form. This form serves as an official documentation tool for your requests. Make sure to provide complete and accurate information on the form to avoid processing delays. Medicare allows submissions via mail or in-person at designated offices.

The CMS 116 form is a request to cancel Medicare Part B coverage. It is specifically designed for individuals who no longer wish to maintain their Part B enrollment. By using the CMS-116 form, you initiate the process to terminate your coverage officially. It is important to understand the implications of cancellation, such as potential gaps in health coverage.

A CLIA number consists of a unique identifier assigned to facilities conducting laboratory tests. The format includes a five-digit prefix followed by a two-digit suffix, creating a sequence of seven digits. For example, a typical CLIA number may look like this: 12D1234567. This identification ensures compliance with laboratory standards under the Clinical Laboratory Improvement Amendments.

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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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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
CMS-116
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