FORMCHECKBOX Yes FORMCHECKBOX NoCERTIFICATIONWe the undersigned certify that all the information given on this application and on the accompanying attachments is true, correct and complete as of this date and that notification, by certified mail, of any change(s) will be made within 14 days of such change(s). @@@ I T k ! & 0 1 ? I $$ T H 4 \ p%) @ ] ( $$ T H 4 ) $ !z * $$ T H 4 ) E|z(Xt2(]O]+wW3`H(sd5d\Pf4UP~=;n=d(+(l~C%RH?Ob@}x"ALk=H@nhD$R/2"`GX]Ecw}Z r,{{PGYgVlK:/1(qZd@kJ `H The State of NJ site may contain optional links, information, services and/or content from other websites operated by third parties that are provided as a convenience, such as Google Translate. Governor Sheila Oliver, Improving Health Through Leadership and Innovation, If you or your organization are involved in human milk banking and wish to respond to the Departments survey, please do so via this link by May 26, 2023, Enterics and Special Bacteriology Laboratories, Chemical Terrorism, Biomonitoring, Medicinal Marijuana and Food Testing Laboratory, http://healthsurveys.nj.gov/NoviSurvey/n/zz3k4.aspx. 8:45-1.3(b), laboratories that have not submitted their 2022 License Renewal Application(s) (CL-3 and/or CL-18 . $ !z B ? and to permit CLiS Licensing staff adequate time for review and approval. In the event ofadiscrepancy, visit theCMS CLIA Laboratory Demographics Lookup and click on CLIA Laboratory Lookup under Tools to verifylaboratoryinformation. 6 26 CDC twenty four seven. F O R M C H E C K B O X Y e s F O R M C H E C K B O X No4. for the next edition. $ ! Switch to Business Search . P The new enactments require: 1) clinical laboratories to record and report certain patient demographic information, namely race, ethnicity, sexual orientation and gender identity; 2) clinical laboratory electronic medical records systems and manual requisition forms to include demographic data entry features; and 3) clinical laboratories to 0000005536 00000 n h$ !z ( $$ T H 4 ) z$ !z ( $$ T H 4 ) Temporary Emergency License for Out-of-State Practitioners 7. Explore a rich library of content on registering, hiring, funding, and more. x $ ! The user is on notice that neither the State of NJ site nor its operators review any of the services, information and/or content from anything that may be linked to the State of NJ site for any reason. Certification requests can only be submitted by the licensee and can only be sent to the licensee or the licensing authority of another state or jurisdiction. : any time. endstream endobj 21 0 obj <>stream 0000003451 00000 n $ j 5CJ OJ QJ U jH 5CJ OJ QJ U j 5CJ OJ QJ U j\ 5CJ OJ QJ U OJ QJ j 5CJ OJ QJ UmH j 5CJ OJ QJ U j 5CJ OJ QJ U CJ OJ QJ 5CJ OJ QJ 1 The Office of Quality Assurance (OQA) offers certification for environmental testing laboratories to ensure that regulatory decisions made by federal, state, and municipal government agencies are based upon accurate and dependable analytical data. Your email has been added to the limited Investigates errors and complaints which jeopardize the health and safety of patients. ( $ ! FORMCHECKBOX Yes FORMCHECKBOX No6. 0000001413 00000 n Contact CMS directly at CMS Lab Excellence for questions about a CLIA certificate. In accordance with N.JAC. Enter any combination of a first name, a last name, license number, and a city . The State of NJ site may contain optional links, information, services and/or content from other websites operated by third parties that are provided as a convenience, such as Google Translate. endstream endobj 20 0 obj <>stream Google Translate is an online service for which the user pays nothing to obtain a purported language translation. You do not need to spell the names or city in full but you must use at least 2 characters for any search option used. You will no longer receive a paper license in the mail. Lt. Cookies used to make website functionality more relevant to you. Certification must be renewed annually. NOTE: If you are unable to see the facility you are assigned to, please call us at (609) 292-6552 or email us at HFSPortal@doh.nj.gov. L N l -Read Full Disclaimer. CJ OJ QJ U )f g u v 6 . To improve search accuracy. ( $ ! 0000008820 00000 n 0000008108 00000 n NJ Government Agency Access (within the state firewall) Via the Department of Law and Public Safety's Intranet. $ ! License Verification Online Access: General Public: Via the Internet NJ Government Agency Access (within the state firewall): Via the Department of Law and Public Safety's Intranet Written Verifications If you need written verification of a licensee's status, either write or fax the Board at: State Board of Medical Examiners P 0000000816 00000 n Brief. Otherwise, select Person Search. startxref All New Jersey Clinical Laboratory Owners or Directors: Under aforementioned New Jersey Clinical Laboratory Improvement Act (the Act), N.J.S.A. Facebook Trenton, NJ 08625-0361 APPLICATION FOR A CLINICAL LABORATORY LICENSE . 0 2 > l n pj" 5CJ OJ QJ U j 5CJ OJ QJ U j6 5CJ OJ QJ U j 5CJ OJ QJ U jJ 5CJ OJ QJ U CJ OJ QJ OJ QJ 5CJ OJ QJ j 5CJ OJ QJ UmH j 5CJ OJ QJ U j 5CJ OJ QJ U, n v ( * > @ B L N P R T v z | x jp 5CJ OJ QJ U j 5CJ OJ QJ U j 5CJ OJ QJ U j 5CJ OJ QJ U j 5CJ OJ QJ UmH j 5CJ OJ QJ U 5CJ OJ QJ OJ QJ >*CJ OJ QJ CJ OJ QJ j 5CJ OJ QJ U/ ( Z| S $ $I $$ T H 4 \ p%)` $ $ ! C`RiRr(#YE"J\&9,;="Ylr^Kh"A L\&M\\#-O m`{* 'G>Ax)rUJ7G3^S(_0.%ZUbo^}Y\^MgjW.N5BEa@O?n?P2RgcZqA7WsFh. Certification of laboratories is an ongoing process. Saving Lives, Protecting People, information about CLIA-certified laboratories using CLIA number, the search function, enter laboratory names. DO NOT put a space between the comma and the first name as this will produce . $ $ ! 2021, c. 454 as amended by P.L. 5CJ OJ QJ U j 5CJ OJ QJ U OJ QJ 5CJ OJ QJ CJ OJ QJ j 5CJ OJ QJ UmH j 5CJ OJ QJ U j4 5CJ OJ QJ U*8 : X B I $$ T H 4 \ p%)` $ $ ! Renewal Fee: Laboratory Directors $40; Medical Technologists, Medical Laboratory Technicians, Clinical Laboratory Specialists and Cytotechnologists $30. The Department also issues written verification of licensure confirming an individual is licensed in NYS and their registration status. L If you are uncertain of the spelling or if abbreviation is possible, try a partial word. For any questions related to Kitchen/Pool/Spa permits in Health Facilities please email us at: EHSHCQC@health.nv.gov OR. & $ ! $ & ( 2 4 6 8 : X Z n p r | ~ # $ % 5 6 D E F Z [ i y j CJ OJ QJ Uj Do you have a lease/rental agreement FORMCHECKBOX Yes FORMCHECKBOX No If yes, please enclose a copy of the lease/rental agreement, and a scale floor plan of the Collection Station that illustrates the relationship between the Collection Station and any other health services purveyor(s).5. : any time. N N ` b b N N N N ` @ N N ` R `db b " X New Jersey Department of Health Clinical Laboratory Improvement Services PO Box 361 Trenton, NJ 08625-0361APPLICATION FOR A CLINICAL LABORATORY LICENSE (COLLECTION STATION ONLY-$200) Type of Application FORMCHECKBOX Initial FORMCHECKBOX RenewalFOR STATE USE ONLY:Date ReceivedReceived By FORMCHECKBOX ApprovedCheck NumberAmountCheck Date Name of Collection Station FORMTEXT N a m e o f P a r e n t L a b F O R M T E X T S t r e e t A d d r e s s F O R M T E X T S t r e e t A d d r e s s F O R M T E X T C i t y , S t a t e , Z i p C o d e F O R M T E X T C i t y , S t a t e , Z i p C o d e F O R M T E X T C L I S I D N u m b e r F O R M T E X T N o r m a l H o u r s o f O p e r a t i o n o f C o l l e c t i o n S t a t i o n [ I n d i c a t e s p e c i f i c h o u r s E A C H d a y ] : N a m e o f C o n t a c t P e r s o n F O R M T E X T M o n d a y F O R M T E X T T u e s d a y F O R M T E X T T e l e p h o n e N u m b e r ( F O R M T E X T ) F O R M T E X T W e d n e s d a y F O R M T E X T T h u r s d a y F O R M T E X T F a x N u m b e r ( F O R M T E X T ) F O R M T E X T F r i d a y F O R M T E X T S a t u r d a y F O R M T E X T E - M a i l A d d r e s s F O R M T E X T S u n d a y F O R M T E X T P H Y S I C A L P L A N T 1 . The CAP proficiency programs supplement QDx internal quality management system, ensuring that the testing and professional consultative services we provide you are accurate, precise and reliable. 10700 West Higgins Rd, Suite 150 General Public Access: Via the Internet. $ 0000004165 00000 n Enter any combination of a first name, a last name, license number, and a city . Our board-certified staffed New Jersey lab serves the diagnostic needs of medical professionals and facilities throughout the United States. Select a license type (optional) and/or a status (optional). Centers for Disease Control and Prevention. %PDF-1.4 % Start QDx Pathology Services is a fully accredited national, CLIA-certified laboratory We are licensed to perform laboratory testing for providers, medical centers, and hospitals throughout the nation, in all 50 U.S. states.
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