Crosswalk

Revisions to Form CMS-209, Laboratory Personnel Report (CLIA) Form
Section # on CMS209
4. Instructions

Type of Change

Reason for the Change

Delete: instruction step “b.” and “d.”
Re-label instruction step “c.” to “b.”
Delete fillable columns “b.” & “d.”
Re-label column “c.” to “b.”

Not needed for CLIA compliance

4. Instructions

Revise language under instruction “a.” to
clearly state the different positions to be
completed for moderate and high complexity
laboratories

Communicate more clearly
information needed and to enhance
completion of form

Gray shaded, For
Official Use Only
column
Data entry rows
Instructions Form
CMS-209 on page 2

Lighten gray area to least amount of shading

Enhance faxing of form

Increase height of rows
Revise language under instruction to:
• Specify that only one person may be
listed as the laboratory director,
• Clearly state the different positions to be
completed for moderate and high
complexity laboratories,
• Not list individuals perform waived
testing, no testing and administrative
functions, and
• Use a separate line for individuals
performing more than one CLIA
position.

Enhance completion of form
Enhance completion of form

1