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DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICESCLIA ADVERSE ACTION EXTRACT
CMS FORM 462A: HARD COPY TO BE COMPLETED BY THE STATE OR RO:
1. PROVIDER NUMBER (CLI AID
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How to fill out clia adverse action extract
How to fill out clia adverse action extract
01
Access the CLIA adverse action extract form.
02
Fill in the required information such as facility name, contact information, and CLIA number.
03
Provide details about the adverse action being reported, including the reason for the action and any supporting documents.
04
Submit the completed form as per the instructions provided.
Who needs clia adverse action extract?
01
Healthcare facilities and laboratories that are subject to CLIA regulations need to fill out the CLIA adverse action extract.
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What is clia adverse action extract?
Clia adverse action extract is a report that provides information on adverse actions taken against clinical laboratory personnel.
Who is required to file clia adverse action extract?
All clinical laboratories are required to file clia adverse action extract.
How to fill out clia adverse action extract?
Clia adverse action extract can be filled out online through the CLIA database using the required information.
What is the purpose of clia adverse action extract?
The purpose of clia adverse action extract is to ensure the safety and integrity of clinical laboratory personnel and to track any adverse actions taken.
What information must be reported on clia adverse action extract?
Information such as the name of the individual, adverse action taken, date of action, and reason for the action must be reported on clia adverse action extract.
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