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PRINTED: 08/30/2021 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:OUTWARD BOUND COMMUNITY SERVICES
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How to fill out clinical laboratory improvement amendments

01
Review the CLIA requirements specific to your laboratory's testing capabilities.
02
Gather necessary documentation, including laboratory personnel qualifications, test procedures, and quality control measures.
03
Complete the CLIA application form provided by the Centers for Medicare & Medicaid Services (CMS).
04
Determine the appropriate laboratory classification for your facility (e.g., waived, moderate complexity, high complexity).
05
Submit the application along with any required fees to the designated state agency or CMS.
06
Once approved, ensure ongoing compliance by conducting regular quality assurance checks and submitting any required reports.

Who needs clinical laboratory improvement amendments?

01
Any laboratory performing diagnostic tests on human specimens.
02
Clinical laboratories seeking to receive federal funding or reimbursement for testing services.
03
Laboratories that wish to ensure they meet standardized quality and safety requirements.
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The Clinical Laboratory Improvement Amendments (CLIA) are U.S. federal regulations that set standards for laboratory testing to ensure the accuracy, reliability, and timeliness of patient test results.
Any laboratory that performs tests on human specimens for health assessments or to diagnose, prevent, or treat diseases must file for CLIA certification.
To fill out CLIA, laboratories must complete the CMS-116 application form, providing information about the laboratory's ownership, location, and services provided, followed by submitting it to the appropriate state agency or CMS.
The purpose of CLIA is to establish quality standards for laboratory testing that assure the safety and accuracy of laboratory tests, thereby protecting public health.
Laboratories must report information regarding their ownership, the types of tests they perform, laboratory personnel qualifications, and quality assurance practices.
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