crosswalk

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

Type of Change

Reason for the Change

Bolded the existing words “follow
instructions on reverse”.

4. Instructions, under
a.

Re-worded "moderate complexity
laboratories", to “laboratories performing
moderate complexity testing; and “high
complexity laboratories” to “laboratories
preforming high complexity testing”.
Added a section to collect the printed name
of the laboratory director below the section
to collect the Laboratory Director signature.
Under Instruction 2, re-worded "moderate
complexity laboratories", to “laboratories
performing moderate complexity testing; and
“high complexity laboratories” to
“laboratories preforming high complexity
testing”.
Added regulatory text to the number bullets
on the Grid list under instruction #5.

Communicates more clearly
information needed and to enhance
completion of form
Communicates more clearly
information needed and to enhance
completion of form

Page 1

Instructions Form
CMS-209 on page 2

Instructions Form
CMS-209 on page 2

Enhances completion of form

Communicates more clearly
information needed and to enhance
completion of form

Communicates more clearly
information needed and to enhance
completion of form

1