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Certificate - LabCE DOT UA Collection
- 1. This is tocertify that: Graham Smith has successfully completed the course: Department of Transportation (DOT) Federally Regulated Urine Specimen Collection Training Provider Name: MediaLab, Inc. ASCLS P.A.C.E. Provider #578 Florida Board of Clinical Laboratory Personnel Provider #5010293 Date Completed: 8/6/2015 Assignment#: 8642023 Content: Complete Exam: 90% Checklist Tasks: Complete (5 of 5 checklist tasks) Continuing Education Credits P.A.C.E. Contact Hours: 2.5 Florida Board of Clinical Laboratory Science CE General: 2.5 P.A.C.E. Contact Hours Course Number: 57801011 This program is approved for 2.5 P.A.C.E.® contact hours. Paul Fekete, MD, Program Administrator MediaLab Inc. (Provider #578) 242 S. Culver St, Suite 300, Lawrenceville, GA 30046 www.MediaLabInc.net | www.LabCE.com P.A.C.E.® American Society for Clinical Laboratory Science 1861 International Drive, Suite 200, McLean, VA 22102 MediaLab is approved as a provider of continuing education programs in the clinical laboratory sciences by the ASCLS P.A.C.E.® Program. California Accrediting Agency (CAA) #0001 Florida Board of Clinical Laboratory Science CE General This course qualifies for 2.5 credit hour(s) towards the Florida Board of Clinical Laboratory Science requirement in General.
- 2. Checklist: Department ofTransportation (DOT) Federally Regulated Urine Specimen Collection Training Assigned to: Graham Smith Date: 8/6/2015 Checklist status: Complete Applicable CLIA Competency Assessment Procedures: No CLIA competency assessment procedures are specified for this checklist. The following checklist items must be performed in the presence of a qualified collector, who has demonstrated necessary knowledge, skills, and abilities by meeting one or more of the following critera: (i) Regularly conducting DOT drug test collections for a period of at least a year; (ii) Conducting collector training under this part for a year; or (iii) Successfully completing a "train the trainer" course. The qualified collector's name and contact information (including email and phone number) must be listed in the comment field for each task that he / she observed. By checking the Y (Meets standard) column and providing his / her name and contact information, the collector attests in writing that he / she is a qualified collector as described above, and that the observed mock collection was errorfree. Save Changes N Y n/a N = Does not meet standard; Y = Meets standard; n/a = Not applicable Comments 8/6/2015 Task 1: 1. Uneventful collection. Perform an uneventful urine collection in the presence of a qualified collector. Denise Harrison 9077904111 leadma@juneauurgentcare.com 8/6/2015 Task 2: 2. Uneventful collection Perform a second uneventful urine collection in the presence of a qualified collector. Denise Harrison 9077904111 leadma@juneauurgentcare.com 8/6/2015 Task 3: 3. Collection of specimen in which temperature of the urine specimen is outside the acceptable rang Perform a urine collection in which the temperature of the urine specimen is out of range, in the presence of a qualified collector. Denise Harrison 9077904111 leadma@juneauurgentcare.com 8/6/2015 Task 4: 4. Collection of specimen in which quantity is not sufficient. Perform a collection in which the quantity of urine is not sufficient, in the presence of a qualified collector. Denise Harrison 9077904111 leadma@juneauurgentcare.com 8/6/2015 Task 5: 5. Donor refusal. Perform, in the presence of a qualified collector, a urine collection in which the donor refuses to sign either the certification on the pink copy of the CCF, or initial the security strips. Denise Harrison 9077904111 leadma@juneauurgentcare.com N Y n/a N = Does not meet standard; Y = Meets standard; n/a = Not applicable Comments Save Changes