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STATE OF TENNESSEE DEPARTMENT OF HEALTH MEDICAL LABORATORY BOARD DIVISION OF HEALTH RELATED BOARDS 227 FRENCH LANDING, SUITE 300 HERITAGE PLACE, METROCENTER NASHVILLE, TN 37243 (615) 532-3202 1-800-778-4123
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How to fill out tennessee clia application form
How to fill out Tennessee CLIA application form:
01
Obtain the necessary application form from the Tennessee Department of Health or download it from their website.
02
Carefully read through the instructions provided on the form, as well as any accompanying guidelines or documents.
03
Begin filling out the form by providing your personal information, such as your name, address, contact information, and any credentials or qualifications required.
04
Provide detailed information about your laboratory facility, including its name, address, type of laboratory, and any certifications or accreditations it holds.
05
Indicate the tests and services your laboratory offers and provide any relevant certifications or licenses for these tests.
06
Include information about your laboratory's personnel, including the names and qualifications of the individuals who will be involved in conducting the tests.
07
If applicable, include any supporting documentation or certifications required as outlined in the instructions.
08
Double-check all the information provided on the form for accuracy and completeness.
09
Sign and date the application form as required.
10
Submit the completed application form, along with any necessary supporting documents and the required fee, to the Tennessee Department of Health.
Who needs Tennessee CLIA application form:
01
Laboratories in Tennessee that perform non-waived laboratory testing procedures.
02
Laboratories that plan to conduct tests on human specimens for the purpose of diagnosis, prevention, or treatment of any disease or impairment.
03
Laboratories that intend to participate in proficiency testing programs or undergo inspections by the Tennessee Department of Health.
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What is tennessee clia application form?
The Tennessee CLIA (Clinical Laboratory Improvement Amendments) application form is a document that laboratories in Tennessee must complete in order to obtain or renew their CLIA certification.
Who is required to file tennessee clia application form?
All laboratories in Tennessee that perform clinical testing on human specimens are required to file the Tennessee CLIA application form.
How to fill out tennessee clia application form?
To fill out the Tennessee CLIA application form, you need to provide information about your laboratory, such as its name, address, contact details, types of tests performed, and personnel qualifications. The form can be downloaded from the Tennessee Department of Health website.
What is the purpose of tennessee clia application form?
The purpose of the Tennessee CLIA application form is to ensure that laboratories in the state meet the federal CLIA requirements for quality standards in testing. It allows the Tennessee Department of Health to evaluate and certify laboratories based on their compliance with CLIA regulations.
What information must be reported on tennessee clia application form?
The Tennessee CLIA application form requires laboratories to report information such as their testing specialties, types of tests performed, testing volumes, personnel qualifications, quality control measures, and laboratory director information.
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