CMS012169 | Centers for Medicare & Medicaid Services

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Form #: CMS 116
Form Title: CLINICAL LABORATORY IMPROVEMENT AMENDMENTS OF 1988 (CLIA) APPLICATION FOR CERTIFICATION
Revision Date: 10/01/2010
O.M.B. #: 0938-0581
O.M.B. Expiration Date: 03/31/2014
CMS Manual: N/A
Special Instructions: N/A

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CMS 116 [PDF, 1MB]

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