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Coronavirus Disease 2019 (COVID-19) CLINICAL TEST REQUISITION
STATE OF CONNECTICUTName/address of submitting facility Dr. Katherine A. Kelley State Public Health Laboratory
395 West Street, Rocky
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How to fill out nameaddress of submitting facility
How to fill out nameaddress of submitting facility
01
Start by writing the name of the facility in the designated space.
02
Below the name, provide the complete address of the facility, including the street name, building number, city/town, state/province, and postal code.
03
Make sure to use clear and legible handwriting to avoid any confusion.
04
Double-check the accuracy of the information before submitting the form.
Who needs nameaddress of submitting facility?
01
The name and address of the submitting facility are typically required by organizations or authorities that need to establish the origin or contact information of the facility. This can include government agencies, regulatory bodies, licensing authorities, or parties involved in legal or administrative processes.
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What is nameaddress of submitting facility?
The name and address of the submitting facility refer to the specific name and physical address of the organization or establishment that is submitting the required information or documentation.
Who is required to file nameaddress of submitting facility?
Any organization or entity that is mandated by regulatory requirements to submit specific documentation related to its operations must file the name and address of the submitting facility.
How to fill out nameaddress of submitting facility?
To fill out the name and address of the submitting facility, provide the official name of the facility followed by the complete physical address, including street number, street name, city, state, and zip code.
What is the purpose of nameaddress of submitting facility?
The purpose of providing the name and address of the submitting facility is to ensure accurate identification of the entity responsible for submitting documents, facilitating communication and compliance with regulatory requirements.
What information must be reported on nameaddress of submitting facility?
The information that must be reported includes the complete legal name of the submitting facility, its physical address, and any applicable identification numbers or designations as required by the regulatory body.
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