-Read Full Disclaimer. $ & ( 2 4 6 8 : X Z n p r | ~ # $ % 5 6 D E F Z [ i y j CJ OJ QJ Uj 12 plenary license as a bio-analytical laboratory director. 4 N X \ ^ | 2 @ l ( B L P R T v 0000004165 00000 n endstream endobj 20 0 obj <>stream _ Careers - NJ Labs | Analytical Chemistry & Microbiology Laboratory < If you are using the proper name of an individual ('John Public', for example), enter the last name first, followed by a comma, then the first name (as in 'Public,John'). @ A O P ^ _ ` d e f g v ; T U m n CJ OJ QJ CJ OJ QJ 5CJ OJ QJ CJ 5CJ OJ QJ jl CJ OJ QJ Uj CJ OJ QJ UOJ QJ j CJ OJ QJ UCJ OJ QJ j CJ OJ QJ Uj $ 0000006138 00000 n American Medical Technologists (AMT) > Verify suggestions, You are now signed up for the AMT Educator (b) Each license to operate a clinical laboratory will . PO Box 361. 0000001092 00000 n 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. N $ !z ( $$ T H 4 ) * , . 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. Welcome to New Jersey's DCA MyLicense Site Select a profession and/or licensee type . This tool allows users to searchdemographicinformation about CLIA-certified laboratories using CLIA numbers, facility names, addresses, geographic locations, or typesof CLIA certificates. QDx is committed to providing the highest level of quality and service to its provider customers and their patients. / ; J K V W X Y Z g n y z { 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 . 0000007370 00000 n 1975, commonly known as the New Jersey Clinical Laboratory Improvement Act, shall be made on forms provided for that purpose by the New Jersey State Department of Health. j New Jersey Department of Health 369 South Warren Street, 6th Floor Trenton, NJ 08608-2308 Top ^ Division of HIV, STD (Sexually Transmitted Diseases) and TB (Tuberculosis) Services Click here to submit an online OPRA request related to the following areas: Office of Assistant Commissioner Administration and Finance Grants Monitoring Unit H "New medical discoveries and the rapid development of new laboratory technologies requires laboratory professionals to maintain and enhance their skills. The OQA certifies laboratories in 36 states, Canada and overseas, and offers certification in: 0000000816 00000 n 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. $ 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 distribution list In the event ofadiscrepancy, visit theCMS CLIA Laboratory Demographics Lookup and click on CLIA Laboratory Lookup under Tools to verifylaboratoryinformation. About us. / ; V $$ ! 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%)` $ $ ! New Jersey Lab Licensing Information - CLIA Requirements
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