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PRINTED: 08/07/2018 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:(X3) DATE SURVEY COMPLETED02/01/2018STREET

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How to fill out clia certificate of waiver

01

Obtain the CLIA Certificate of Waiver application form from the Centers for Medicare & Medicaid Services (CMS) website.

02

Fill out the application form completely and accurately, providing all required information about your facility and testing procedures.

03

Submit the completed application form along with any necessary documentation and fees to the appropriate CMS regional office.

04

Wait for approval from CMS before beginning any waived testing procedures at your facility.

Who needs clia certificate of waiver?

01

Any facility or laboratory that performs waived testing procedures as defined by CLIA regulations needs a CLIA Certificate of Waiver.

02

This includes facilities such as physician offices, pharmacies, and other healthcare providers who perform simple tests with a low risk of error.

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What is clia certificate of waiver?

CLIA Certificate of Waiver is a certificate issued by the Clinical Laboratory Improvement Amendments (CLIA) program that allows certain laboratory tests to be waived from certain testing requirements.

Who is required to file clia certificate of waiver?

Healthcare facilities or providers that perform waived tests are required to file for a CLIA Certificate of Waiver.

How to fill out clia certificate of waiver?

To fill out a CLIA Certificate of Waiver, the healthcare facility or provider must complete the necessary forms and provide all required information about the waived tests being conducted.

What is the purpose of clia certificate of waiver?

The purpose of a CLIA Certificate of Waiver is to ensure that waived tests are performed accurately and safely by healthcare facilities or providers.

What information must be reported on clia certificate of waiver?

The CLIA Certificate of Waiver must include information about the healthcare facility or provider, the waived tests being performed, and any other relevant details.

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