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FACILITY USE REQUEST FORM - Clover Sites

FACILITY USE REQUEST FORM - Clover Sites 2025

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The document is a CHANGE REQUEST AUTHORIZATION form used to request missing information or corrections related to specimen submissions at Kansas Health & Environmental Laboratories (KHEL). It requires the completion of specific demographic details and authorizes changes to be made, ensuring compliance with federal laboratory regulations. The form must be signed and submitted via fax or email, and it includes confidentiality notices regarding the information contained within.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (177 Votes)
2019	4.4 Satisfied (139 Votes)

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