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ASCLS
The American Society for Clinical Laboratory Science
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Patient Safety Benchmark Peer Reporting Program-Registration

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  2. 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 Address(Required)
Submitters Name(Required)
Must be an ASCLS Member.
Submitter's Email(Required)

Contacts

Primary Contact Name(Required)
Secondary Contact Name

Laboratory Certification

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

Laboratory Demographics

Testing Complexity Levels(Required)
Check all that apply.
Testing Specialties(Required)
Select all testing specialties that are performed within your clinical laboratory.
Select the one most descriptive of facility type.
If "Other" was chosen for laboratory type, please specify the type of laboratory.
Does your CLIA ID/certification allow multiple testing locations under your single CLIA certificate?
Briefly list additional locations where testing is performed.
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.
ASCLS
The American Society for Clinical Laboratory Science
P.O. Box 92 | Dundee, MI 48131
Ph. 301.478.6379 | Email ascls@ascls.org

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