"List of Tests Performed on-Site and Annual Test Volume Report" - Connecticut

List of Tests Performed on-Site and Annual Test Volume Report is a legal document that was released by the Connecticut State Department of Public Health - a government authority operating within Connecticut.

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LIST OF TESTS PERFORMED ON-SITE & ANNUAL TEST VOLUME REPORT.
Laboratory Name: __________________________________________________________________.
Laboratory Address: ____________________________________________. Date: ______________.
For each test performed in your laboratory, list the test performed, instrument or method used, the
estimated annual test volume, and (if applicable).the proficiency testing program (CAP, AAB, EXCEL,
MLE, API, AAP, etc), that you are enrolled in. Continue on next page if necessary.
Test
Instrument / Kit
PT
Annual
CPT Code
Complexity
Specialty
Program
Volume
CAP, AAB
etc
______________________________________________
_________________
Signature of Director
Date
LIST OF TESTS PERFORMED ON-SITE & ANNUAL TEST VOLUME REPORT.
Laboratory Name: __________________________________________________________________.
Laboratory Address: ____________________________________________. Date: ______________.
For each test performed in your laboratory, list the test performed, instrument or method used, the
estimated annual test volume, and (if applicable).the proficiency testing program (CAP, AAB, EXCEL,
MLE, API, AAP, etc), that you are enrolled in. Continue on next page if necessary.
Test
Instrument / Kit
PT
Annual
CPT Code
Complexity
Specialty
Program
Volume
CAP, AAB
etc
______________________________________________
_________________
Signature of Director
Date