A r e q u a r t e r s s h a r e d w i t h a n y o t h e r e n t e r p r i s e ? These cookies may also be used for advertising purposes by these third parties. Section 8:45-1.1 - Initial licensure (a) Application for an initial license to conduct a clinical laboratory, as required under the provisions of Chapter 166, P.L. In the event ofadiscrepancy, visit theCMS CLIA Laboratory Demographics Lookup and click on CLIA Laboratory Lookup under Tools to verifylaboratoryinformation. 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%)` $ $ ! 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. CL-18, Application for Clinical Lab License, Collection Station Only f Twitter Welcome to New Jersey's DCA MyLicense Site cl-18, laboratory, application for clinical laboratory license, clinical laboratory license application, collection station Last modified by: ewhite Created Date: 6/26/2008 6:46:00 PM 0000004007 00000 n any time. NJDEP| Division of Science and Research | Laboratory - State $ ! 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. 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). Verification. v x |n j CJ OJ QJ Uj 5CJ OJ QJ UmH jZ 5CJ OJ QJ U 5CJ OJ QJ j 5CJ OJ QJ U j CJ OJ QJ UOJ QJ jn CJ OJ QJ Uj CJ OJ QJ UCJ OJ QJ j CJ OJ QJ Uj CJ OJ QJ U % . 10700 West Higgins Rd, Suite 150 Reviews records of and/or assesses patient testing, equipment maintenance, quality control, staffing levels, medical records, observes testing procedures as well as patient care and interviews staff. $ ! How to Apply for a CLIA Certificate, Including International Laboratories 4 N X \ ^ | 2 @ l ( B L P R T v 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. 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 . 0000007932 00000 n We take your privacy seriously. 0000001413 00000 n Explore a rich library of content on registering, hiring, funding, and more. ( $ ! (b) Each license to operate a clinical laboratory will . Google Translate is an online service for which the user pays nothing to obtain a purported language translation. The following reports can be found on the Certified Laboratories page of Data Miner: Note: The lists are created from real-time data so it may take up to a minute for the information to display. 3 $$ T H 4 0 ) ( P R T v $ ! J H QDx is committed to providing the highest level of quality and service to its provider customers and their patients. Select a profession and/or licensee type . 0000006138 00000 n Twitter ], National Institute of Diabetes and Digestive and Kidney Diseases, Information For Laboratory Personnel | Monkeypox | Poxvirus | CDC, Advanced Catalog Search (beiresources.org). H1s,&#ZB_ qi4%)<=mDbB?Ymv/vzUs`*RE`N/QG--f>'xWMTYJ/nRBl &FJ|Omt3,^(-bw5TX 609-913-5105 Clinical Laboratory Licensing Program Contact Us Email: Joan.Mikita@doh.nj.gov Phone: 609-406-6830 Fax: 609-406-6863 Mailing/Shipping Addresses: By USPS, mail/ship to- Public Health & Environmental Laboratories NJ Department of Health ATTN: Joan Mikita Clinical Laboratory Licensing Program PO Box 361 Trenton, NJ 08625-0361 <]/Prev 700435>> Call us at 775-684-1030. > O Q N q bjbjt+t+ 0N A A - J ] N N N N N N N b b b b 8 D t b n t S L ( ` b b b b b b $ Q N N N n . NJDOBI Licensee Search - www-dobi.state.nj.us 8:44-2.1 et seq. Welcome to Business.NJ.gov, your one-stop for learning about State, and sometimes federal and local, opportunities and regulations in New Jersey. You will no longer receive a paper license in the mail. Our state licensing map resource was built to help our clinical laboratory clients and medical laboratory scientists find all of the information they need to attain the necessary state personnel and facility licensing. Clinical Laboratory Improvement Services. 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 NJ Division of Consumer Affairs - State Board of Medical Examiners NJ Government Agency Access (within the state firewall) Via the Department of Law and Public Safety's Intranet. Centers for Disease Control and Prevention. Facility Registration Requirements. This tool allows users to searchdemographicinformation about CLIA-certified laboratories using CLIA numbers, facility names, addresses, geographic locations, or typesof CLIA certificates. l I $$ T H 4 \ p%) @ ] ( $$ T H 4 ) $ !z * $$ T H 4 ) Certifications | QDx Pathology Services 0000007370 00000 n Brief. 0 2 1 2 @ A B P Q _ ` a e f A B { | |n j CJ OJ QJ Uj CJ OJ QJ Uj CJ OJ QJ Uj2 CJ OJ QJ Uj 5CJ OJ QJ UmH j 5CJ OJ QJ U 5CJ OJ QJ j 5CJ OJ QJ U OJ QJ CJ OJ QJ j CJ OJ QJ UjF CJ OJ QJ U + e f A B d e f p ~ $ ! I $$ T H 4 \ p%) $ $ ! H 12 plenary license as a bio-analytical laboratory director. P Laboratory Search | CDC Is the Collection Station open to the general public? In addition, we are accredited in the following states that require state CLIA certification. That commitment is embodied in our practice of the 12 essential quality control and quality management processes: QDx Pathology Services is an independent anatomical, molecular and clinical pathology laboratory. : HT G1,LTZEUMca+-jU|m?O/wx-TN;hE(D &M18+BDL'$Boj0z,ge31qgZCboX#tT+4C2rcH)1 &rgEg[h S7Y [V W X Y Z g n y z { W Q ! Increase your testing confidence Utilize AMT study resources. the Centers for Medicare & Medicaid Services (, for CLIA certificate information. The OQA certifies laboratories in 36 states, Canada and overseas, and offers certification in: Methods offered for certification are called Department Sanctioned Analytical Methods (DSAMs) and include testing for microbiology, toxicity, physical characteristics, nutrients, inorganics, metals, volatile organics, semi-volatile organics, polynuclear aromatic hydrocarbons, polychlorinated biphenyls, dioxins, and radiochemistry.