NDGHA Registration Form 2014- Kings CoPHL2014
NDGHA Site Registration Form 2014-Kings CoPHL2014
NDGHA Compliance Checklist Form KCPHL2014
The NDGHA program authorizes local health jurisdictions to approve applications from private entities wishing to conduct bioanalytical screening for asymptomatic individuals in the local jurisdiction. These tests are designed to screen for a non-infectious chronic health condition. Applicants must have plans in place to refer individuals who appear to have a marker or risk factor to licensed sources of care for appropriate follow up. One of the prime objectives of the law is to regulate the operation of NDGHA operations (e.g. public screening programs for cholesterol, glucose, triglycerides, etc). The law assures the public of safe and quality assured test results at NDGHA operations. The law mandates the operation of NDGHA programs within certain quality assurance, safety, and client information requirements. The required documentation includes information on type, times, dates, location, quality assurance, client counseling, and safety provisions of the program. Only fingerstick methods of blood collection are allowed. No venipuncture is allowed. Operators must file at least 30 days before conducting an event. Hospitals, licensed community clinics, free clinics, and employees clinics are not considered NDGHA programs and are exempt. There is no fee required to for this permit. (California Business and Professions Code, Chapter 195, Sections 1244, 1244.1, 1244.3 and 1244.4).
Applicants must fill out the attached documents and submit them via e-mail to James.Spolsdoff@co.kings.ca.us at least 30 days before they have a NDGHA event in Kings County. The first Excel form is the NDGHA Registration Form 2014. The second Excel form is the NDGHA Site Registration Form 2014. The first form provides information regarding name of organization, address, contact information, names of owners, physicians, CLIA number, PPG’s, testing equipment and applicant signatures. The second Excel form (site registration form) identifies where the applicant will have the NDGHA event in Kings County.
Also find attached “Testing Site Survey” (Word.doc) that is a checklist to assist applicants in meeting all requirements. The list includes some recommendations as well.
Applicants must inform the Department as to how they will dispose of their medical waste (mail back programs are allowed). A State or County Environmental Health Division medical waste permit is also required. Please contact Kings County Environmental Health at (559) 584-1411 to apply for this if your agency does not already have said permit.
For questions about the NDGHA application process, feel free to call (559) 852-2607.