Instructions for Completion of State of Maryland Tissue Bank - DHMH - dhmh maryland 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Section I, 'Tissue Bank Information.' Provide details such as the Director's name, laboratory practice/entity name, and contact information. Ensure all fields are completed accurately.
3. Proceed to Section II for 'Medical Director Information.' Enter the Medical Director's name, degree, and state medical license number. Indicate whether they are full-time or part-time.
4. In Section III, complete the 'Technical Director Information' similarly. Include their qualifications and hours worked per week.
5. Section IV requires ownership details. List names and addresses of individuals or organizations with a controlling interest in the entity.
6. For Section V, provide accreditation information if applicable. If your laboratory is accredited, include the accrediting organization's name and last survey date.
7. In Section VI, check all relevant tissue types associated with your bank. If any testing is performed, indicate this clearly.
8. Finally, complete the attestation section by signing and dating it to certify that all provided information is accurate.

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