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pdfDepartment of Health and Human Services
Centers for Medicare & Medicaid Services
Form Approved
OMB NO 0938-0599
Planned Workload Report
Clinical Laboratory Improvement Amendments Program
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Jeffrey Pleines.
Region/State Code:
FY Quarter: 2/2004
4 / Alabama
From: 1/1/2004 To: 3/31/2004
Agency Name:
Alabama Department of Public Health
Type of Laboratory
Number
Of Sites
(A)
Initial
Visits
(B)
Resurvey
Follow-Up
Visits
(C)
Visits
(D)
Compliant
Visits
(E)
Total
Visits
(F)
1
Waived/PPMP
0
0
0
0
0
0
2
Accredited
0
0
0
0
0
0
3
Low Volume Schedule
0
0
0
0
0
0
4
Schedule A
0
0
0
0
0
0
5
Schedule B
0
0
0
0
0
0
6
Schedule C
0
0
0
0
0
0
7
Schedule D
0
0
0
0
0
0
8
Schedule E
0
0
0
0
0
0
9
Schedule F
0
0
0
0
0
0
10
Schedule G
0
0
0
0
0
0
11
Schedule H
0
0
0
0
0
0
12
Schedule I
0
0
0
0
0
0
13
Schedule J
0
0
0
0
0
0
14
Totals
0
0
0
0
0
0
Date:
Form CMS - 105
Signature:
Title:
Date Revised: 04/28/2004
Wednesday, April 28, 2004 - 03:44 PM
| File Type | application/pdf |
| File Title | CMS-105 |
| Author | Jeffrey Pleines |
| File Modified | 2017-11-13 |
| File Created | 2017-11-13 |