Transcription of LABORATORY PERSONNEL QUALIFICATION …
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LABORATORY PERSONNEL QUALIFICATION …
1 CLTL - 103 LABORATORY PERSONNEL QUALIFICATION APPRAISALand APPLICATION FOR LICENSUREWEST virginia DEPARTMENT OF HEALTH AND HUMAN RESOURCESOFFICE OF LABORATORY SERVICES167 11th AvenueSouth Charleston, west virginia 25303 Name Social Security Number - - LABORATORY CLIA Certificate No. GENERAL in ink or type all information. Avoid abbreviations, if possible. Do not abbreviate name ofcity or all items that apply to you. If more space is required, specific pages may be check or money order, ($ ) to the application payable to State of west VirginiaDHHR Lab.
1 cltl - 103 laboratory personnel qualification appraisal and application for licensure west virginia department of health and human resources office of laboratory services
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