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CA CDPH LAB 155 2009 free printable template

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Use supplementary sheet if necessary. Unincorporated association LAB 155 1/09 Page 1 of 2 District city county or state Other specify if nonprofit submit proof of nonprofit status 6. State of California Health and Human Services Agency California Department of Public Health APPLICATION-- CLINICAL LABORATORY REGISTRATION Refer to California Business and Professions Code Division 2 Chapter 3 Instructions Use typewriter or print in ink. Complete both pages of this application and return with...
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How to fill out CA CDPH LAB 155

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Begin with the header section: Fill in the date, laboratory name, address, and contact information.
02
Specify the type of laboratory services provided by checking the appropriate boxes.
03
Enter the participant's information, including name, address, and contact details.
04
List the tests performed by including the test name, date of test, and results.
05
Complete the quality assurance section by providing details of any quality control measures taken.
06
Sign and date the form at the bottom to certify that the information is accurate and complete.

Who needs CA CDPH LAB 155?

01
Laboratories providing clinical and environmental testing.
02
Healthcare providers needing to submit laboratory results.
03
Public health officials for monitoring and regulating laboratory practices.

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CA CDPH LAB 155 is a laboratory reporting form used by the California Department of Public Health (CDPH) for laboratories to submit information about communicable diseases and specific laboratory test results.
All licensed clinical laboratories in California that perform specific tests for reportable communicable diseases are required to file CA CDPH LAB 155.
To fill out CA CDPH LAB 155, laboratories should provide patient information, test results, and relevant details such as the test date and the laboratory's identification information, ensuring that all fields are accurately completed as per the instructions provided.
The purpose of CA CDPH LAB 155 is to facilitate the tracking and monitoring of communicable diseases, ensuring timely reporting to public health authorities for surveillance and control efforts.
Information that must be reported on CA CDPH LAB 155 includes patient demographics (name, address, date of birth), test results, date of the test, laboratory information, and details regarding the disease or condition being reported.
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