Get List Of Tests Performed - Dhhs Ne

Filling out the LIST OF TESTS PERFORMED form is an essential step for laboratories in Nebraska to ensure compliance with state regulations. This guide provides a clear, step-by-step approach to help you complete the form accurately and efficiently.

Follow the steps to accurately complete the form.

1. Press the ‘Get Form’ button to access the LIST OF TESTS PERFORMED form and open it in your preferred editing software.
2. Begin by entering the lab name in the designated field at the top of the form.
3. Fill in the laboratory address, ensuring you include the city and ZIP code accurately.
4. Input your Clinical Laboratory Improvement Amendments (CLIA) number in the provided space.
5. Select the appropriate certificate type from the options available, which include Certificate, Certificate of Accreditation, Certificate of Provider-Performed Microscopy, and Certificate of Waiver.
6. If you are a new applicant, please list the manufacturer’s name and model of the instrument or the name of the test kit used for patient testing in the specified section.
7. Continue by filling in each test your laboratory performs. For every test, include the method used, the specialty or subspecialty related to the test, and the annual volume of tests conducted.
8. Once all required fields are completed, please provide your signature in the designated space.
9. Enter the date of completion in the designated field.
10. After double-checking all provided information for accuracy, you may save changes, download the form, print it, or share it as needed.

Ensure compliance and accuracy by completing the LIST OF TESTS PERFORMED form online today.