Clia Application ohio Form 2020-2023

Clia Application ohio Form: What You Should Know

In general: CIA is administered by the Medical Laboratory Improvement Program of the Ohio Medicaid agency. If you are requesting the certification of your laboratory through CMS, please go to the website and follow the process. If you need assistance with the FDA form to obtain a laboratory certificate, please contact the Office of Medical Laboratory Improvement at, Monday – Friday 8:00 am — 5:00 pm, Eastern Time. This application must be in order and completed in order to be considered for the NIH grant, and you must provide a valid Social Security number, as well as current, valid driver's license information. The application also requires that you are a U.S. citizen, a U.S. national as defined below, or a resident alien. Please note that an application for an ICD-9-CM code is required. Information required for review or submission:  Names, addresses, telephone numbers, email address, social security numbers, dates of birth, place of birth, and certification numbers of the lab administrators and directors; Whether the laboratory is located at a public, private, community, or academic facility; Provide an indication of whether the laboratory serves the entire population of the facility or only a designated portion; and The approximate number of samples that you are able to provide to the laboratory. Provide documentation for laboratory directors, including current laboratory director contracts (if known) and the location of their laboratory, as well as copies of the lab's policy for testing and reporting. Please include a copy of your current CV if applicable, as well as a copy of your Letter of Professional Conduct and any other current documents that may be applicable to your specific situation. How to fill out the application (CLINT and CLINT/PROGRESSIVE)? For all applicants, submit the following information to the CLINT/PROGRESSIVE. 1. A copy of your ICD 10-10-10-10.5 (IACCP-10-10-10-10.5), which is your lab's policy for testing and reporting. 2. A valid State driver's license, or a U.S. Passport with an IACCP-10- 10-10-10 certification. 3. A current, valid Social Security number. 4. Your name, your address, and identification number (if known) 5. The city, state, and zip code of the facility where you reside.

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