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ASCLS

The American Society for Clinical Laboratory Science

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Membership
Education
Communication
Participate
Advocacy-Issues
Careers
P.A.C.E.
About Us

Patient Safety Benchmark Peer Reporting Program-Registration

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Patient Safety Benchmark Peer Reporting…

General Instructions

Prior to submitting your registration, obtain approval from the appropriate facility leadership to enroll your laboratory in the program and submit your laboratory data to the Peer Comparison Program.
Only ASCLS members may submit registration request. The ASCLS member must be listed as the ‘Submitter’ on this form. ASCLS member ID number is required.
Prior to filling out this form verify that you have all registration information required.

Resource: Patient Safety Benchmark Peer Reporting Program User Guide.

Laboratory Name(Required)

Laboratory Address(Required)

Street Address Address Line 2 City State ZIP Code

Submitters Name(Required)

Must be an ASCLS Member.

First Last

ASCLS Member ID Number(Required)

Submitter's Email(Required)

Enter Email Confirm Email

Contacts

Primary Contact Name(Required)

First Last

Primary Contact Email(Required)

Secondary Contact Name

First Last

Secondary Contact Email

Laboratory Certification

Laboratory Certification Status(Required)

CLIA Number

Make sure and include the "D" in the middle of your CLIA number.

CLIP Number

MTS Number

Clinical Laboratory Permit Number

CLIA Certificate Type(Required)

Laboratory Demographics

Testing Complexity Levels(Required)

Check all that apply.

Waived

PPM

Moderate

High

Testing Specialties(Required)

Select all testing specialties that are performed within your clinical laboratory.

Chemistry (e.g., automated, and manual chemistry, urinalysis, endrocrinology, toxicology)

Hematology (e.g., automated, and manual hematology, coagulation, flow cytometry)

Microbiology (e.g., automated, and manual bacteriology, mycobacteriology, mycology, parasitology, virology, molecular diagnostics)

Immunology (e.g., automated, and manual diagnostic immunology, general immunology, molecular diagnostics)

Immunohematology (e.g., automated, and manual blood type, antibody detection and identification, compatibility testing)

Histocompatibility (transplant, nontransplant)

Genetic Testing (cytogenetic tests, biochemical genetic tests, molecular genetic tests)

Pathology (dermatopathology, histopathology, oral pathology, cytology)

Type of Laboratory(Required)

Select the one most descriptive of facility type.

Specify Other Laboratory Type(Required)

If "Other" was chosen for laboratory type, please specify the type of laboratory.

Multiple Sites(Required)

Does your CLIA ID/certification allow multiple testing locations under your single CLIA certificate?

Multiple Location Details

Briefly list additional locations where testing is performed.

Annual Test Volume(Required)

Refer to ‘Instructions for Counting Tests’

Data precision for this program is critical. Please take the extra step and scroll up to confirm the data entered into each field is correct.

The American Society for Clinical Laboratory Science
P.O. Box 92 | Dundee, MI 48131
Ph. 301.478.6379 | Email ascls@ascls.org

© ASCLS 2025

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