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Freestanding Clinical Laboratories - Monthly Reporting Forms and Instructions

Schedule of Report and Payment Due Dates

2001 (PDF, 12KB, 1pg.)
2000 (PDF, 10KB, 1pg.)
1999 (PDF, 10KB, 1pg.)
1998 (PDF, 9KB, 1pg.)
1997 (PDF, 9KB, 1pg.)

Forms and Instructions

Instructions for Completing Report Forms (PDF,145KB, 11pg)
Certification Form (PDF 137Kb 2pg.)
Payment and Reconciliation Summary (PDF 86Kb 1pg.)
Patient Services Revenues and Surcharge Obligations
- 2000 (PDF 162KB 2pg.)
- 1999 (PDF 159KB 2pg.)
- 1998 (PDF 160KB 2pg.)
- 1997 (PDF 158KB 2pg.)