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Fields
My lab is enrolled and would like to add more sites.
My lab is enrolled and would like to add more sites.
Organization Name
*
CAP # of a Currently Enrolled Lab
*
Enter 7-digit CAP #
Laboratory Information
Laboratory Name
*
CAP #
*
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Add a Laboratory Using the Same LIS
Add a Laboratory Using the Same LIS
Laboratory Name
CAP #
Enter 7-digit CAP #
Information about your Laboratory Information System (LIS)
LIS Utilized
*
LIS Version
*
Contact Information for Laboratory Lead for Direct Transmission Implementation
Lead Contact Name
*
First Name
*
Last Name
*
Email
*
Phone
*
LIS Coordinator/ LIS Manager Contact Information (If different than above)
LIS Contact Name
First Name
Last Name
Email
Phone
*
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