Lab 116 Os Form PDF Details

When it comes to managing laboratory personnel and maintaining compliance with state regulations, the Lab 116 Os form plays a critical role, especially for out-of-state laboratories operating in relation to the California Department of Public Health Laboratory Field Services. Situated in Richmond, CA, this agency oversees the accreditation and personnel standards for laboratories to ensure the highest quality of healthcare services. The form requires detailed information about the laboratory, including its name, CLIA number, physical address, and contact details. It also mandates the listing of laboratory directors and all personnel involved in performing tests, specifying the complexity of the tests each individual is authorised to conduct, whether moderate (M) or high (H) complexity tests. This level of detail ensures that each member of the laboratory team is properly credentialed for their role, supporting the overall goal of safeguarding public health through stringent quality control in laboratory operations. The inclusion of licenses or certificates for each listed individual further solidifies this process, making the Lab 116 Os form a cornerstone document for out-of-state laboratories seeking to comply with California’s rigorous health and human services standards.

QuestionAnswer
Form NameLab 116 Os Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameslab 116 os, 116os, cdph lab 116 form, clia lab 116 form

Form Preview Example

State of California—Health and Human Services Agency

LABORATORY PERSONNEL REPORT

Out-of-State Laboratory

California Department of Public Health

Laboratory Field Services

850 Marina Bay Parkway, Bldg. P, 1st Floor Richmond, CA 94804-6403

Laboratory name

 

CLIA number

 

 

 

 

 

Laboratory address (number, street)

City

State

 

ZIP code

 

 

 

 

Contact person

 

Telephone number

 

 

(

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INSTRUCTIONS: List laboratory director(s), all personnel performing tests, and all personnel responsible for test performance. Mark “M” for moderate complexity tests and “H” for high complexity tests.

 

 

 

 

 

 

DIRECTOR AND/OR PERSONNEL TESTING IN THE FOLLOWING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Last Name

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Type*

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*Include copy of license or certificate for each person.

THIS FORM MAY BE PHOTOCOPIED

LAB 116 OS (7/07)

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