How to use or fill out Certificate of Waiver Medical Test Site (MTS) Application Packet
- Click ‘Get Form’ to open the Certificate of Waiver Medical Test Site Application Packet in our editor.
- Begin with the Index Page (505-038) to familiarize yourself with the contents and structure of the application. This page outlines all necessary documents.
- Refer to the Application Instructions Checklist (505-039). Ensure you have all required documentation ready, including your UBI and FEIN numbers.
- Fill out Section 1: Demographic Information. Enter your business details clearly, including legal owner/operator entity name, mailing address, and contact information.
- Proceed to Section 2: Facility Specific Information. Indicate your site type and hours of operation for laboratory testing.
- Complete Section 3: Key Individuals by providing names and contact details for the lab director and lab contact person.
- In Section 4, list any waived tests you plan to perform. Be specific about test manufacturers and systems used.
- Finally, review Section 5 for any additional licensure information needed. Sign and date the application before submission.
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