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CPT-1 FINAL EXAM

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Question
Answer
What is ASPT   show
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What is AMT   show
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show American Society of Clinical Pathologist (national certifying organization)  
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show National Phlebotomy Association (national certifying oranization)  
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show National Center for Competency Testing (National certifying organization)  
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show National Healthcareer Association (national certifying organization)  
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How many CEU units do you need every two years to renew your state phlebotomy license?   show
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show Issuance by an official body of a certificate to a person indicating that he/she has met certain requirements  
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show legal permission grated by the state to engage in an occupation or activity  
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define Reciprocity   show
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Define integrity   show
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define empathy   show
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show use of good judgement and prudence  
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define diplomacy   show
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define confidentiality   show
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show moral duty to determine the difference between right and wrong  
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show always telling the truth regardless of the situation  
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show verbal, non verbal, and active listening  
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show a gentle caring attitude  
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define dependability   show
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show being responsible for your actions  
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show interprets results to diagnose disease...can be a pathologist or bioanalyst  
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show Day to day operations of lab... liaison between director and lab staff  
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show daily work schedules and staffing ...  
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show Clinical laboratory scientist  
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show Directs work of other lab staff...MAINTAIN QA standards ...  
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show 4year med tech program, 1yr. internship, board exam  
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What is MLT   show
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What are CLT   show
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What do MLT/CLT do   show
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show Test for BLOOD GROUPS, ANTIGENS, and ANTIBODY IDENTIFICATION AND COMPATIBILITY  
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show Clinical analysis...Surgical/anatomical pathology  
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What is the purpose of the chemistry dept.   show
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show Analyzes for presence of microorganisms Ex. of tests C&S , GRAM STAIN TEST  
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What is the purpose of the immunology/serology dept.   show
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show Blood typing and antibody tests..Blood from donors is tested here before being used for transfusions ..THE MAKE NO MISTAKES  
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what is the purpose of the Urinalysis dept   show
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CLSI use to be called what   show
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show Clinical Laboratory Standards Institute  
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show Establishes prcedural guidelines for all areas of the lab(GOLD STANDARD)  
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What is CAP   show
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What does CAP do   show
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Define JCAHO   show
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show Accrediting agency for hospitals and nursing homes ..inspects every two years ..ENFORCE STANDARDS ESABLISHED BY CLSI ..WORKS WITH CAP to provide lab accreditation  
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show Clinical Laboratory Improvement Act of 1988  
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show Enacted by congress to regulate all labs..Include guidelines ...QUALITY CONTROL..QUALITY ASSURANCE...RECORD KEEPING,,PERSONAL QUALIFICATIONS NO AN ORGANIZATION  
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show ENSURE QUALITY LAB TESTING  
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show Invasion of the body with pathogenic(diease causing) bacteria, fungi,viruses, protozoa or parasites  
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What is the primary goal of infection control program   show
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show Pathogenic Organisms in blood that cause disease  
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show Piercing mucous membranes or skin barriers  
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show Infectious Agent...Reservoir..Exit Pathway..Means of Transmission...Entry Pathway..Susceptible Host  
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show disease causing organism  
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give ex. of an infectious agent   show
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give ex. of RESERVOIR   show
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give ex. of EXIT PATHWAY   show
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show airborne, contact, droplet, vector, vehicle  
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give ex. of ENTRY PATHWAY   show
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show elderly, newborn, acute/chronically ill patients, immune suppressed unvaccinated  
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What is a NOSOCOMIAL INFECTION   show
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What is a common nosocomial infection   show
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show OSHA and established by CDC .center of disease control  
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you should change your gloves every   show
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to disinfect equipment and surfaces use   show
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show Skin and mucous membranes  
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define STRICT ISOLATION   show
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show For patients with intestinal infections  
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show for patients with diseases that can be spread by direct contact ..ex MRSA,VRE, and C. Difficile  
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define Protective/reverse/neutropenic isolation   show
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show for patients with diseases spread by droplets that are smaller than 5micrometers example of diseases (TB) Varicela zoster (chicken pox) and measels (SPECIAL REQUIRMENT.NEGATIVE PRESSURE ROOM)  
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show for patients with diseases spread droplets that are larger than 5 micrometers (example PERTUSSIS..meningitis, German measles  
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show occupational Safety and health administration  
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show Assures every person safe and healthful working conditions (FEDERAL AGENCY)  
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show DUST PAN  
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Sharp containers should be replaced when they are   show
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show Prodeuce hormones .EPINEPHRINE and NOR EPINEPHRINE...located on top of each kidney  
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show Aloow for diffusion between air and blood  
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What is Amoiotic fluid   show
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show Largest artery in the body  
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what are ARTERIES   show
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show Smaller branches of the arteries  
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show Upper chambers of the heart  
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show The transport blood ..Include ARTERIES ARTERIOULES CAPILLARIES VENULES and VEINS  
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What are capollaries   show
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show Brings deoxygenated blood to the heart from lower parts of the body  
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show Maintains fluid balance, defends against disease, absorption of fats from blood stream  
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what is PERITONEAL FLUID   show
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What is PLEURAL FLUID   show
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What is the function of the superior vena cava   show
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What is SYNOVIAL FLUID   show
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what do veins do   show
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what are venules   show
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what are ventricles   show
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show test to assess PLATELET PLUG formation in CAPILLARIES (pre surgical)  
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show after centrifuation of a specimen mixed with an anticoagulant, the layer between the plasma and erythrocytes..CONTAINS WBC and PLATELETS  
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show a test that categorizes blood cells and abnormalities present  
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show prevents blood from clotting by binding calcium  
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Hematocrit is also known as   show
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show non-granulocytic WBCs( ASSIST IN IMMUNITY and PRODUCTION OF ANTIBODIES  
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what are MONOCYTES   show
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show it is the liquid portion of whole blood  
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show blood cells that aid in blood clot formation  
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what is serum   show
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show Localized leakage of blood into tissues (most common complication of phlebotomoy)  
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show Closed or constricted vein  
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Define Sclerosed Vein   show
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show Presence of bacteria in the blood  
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What is the purpose of C&S test   show
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define O&P   show
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define Septicemia   show
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define ACIDOSIS   show
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show condition when blood is pH is above 7.45  
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What is a BUN TEST   show
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define LIPEMIC   show
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what is POST PRANDIAL GLUCOST TEST   show
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what is the PREANALYTICAL PHASE   show
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show therapeutic drug monitoring  
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what is the purpose of Citrate   show
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define fibrin   show
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what is the purpose of heparin the green tubes   show
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show patients condition early in the morning.. 12hour after last ingestion of food (fasting)  
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define DHS   show
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What is a Fistula   show
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define Hemolysis   show
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define metabolic acidosis   show
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define metabolic alkalosis   show
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what is the purpose of OSHA   show
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what is the purpose of QC quality control   show
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define QNS   show
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If you leave a tourniquet for more than one minute it can cause   show
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define ANATOMY   show
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show Study of how the body functions  
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define Pathophysiology   show
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Why do we need to draw blood   show
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Blood is the primary means of transport for   show
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show a REQUISITION  
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a requisition can be written in what ways   show
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show patient diagnosis ...patients gender...patients billing information ..  
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If any doubts at any time of a tube what should you do   show
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show Evacuated tube method (straight needle)....Butterfly Method...Syringe Method  
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show anticoagulant or preservative  
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Light Blue Tube   show
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show No additive ..Commonly Requested tube .. (SEROLOGY, SERUM CHEMISTRY TESTS) ex. of test Cholesterol  
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show Clot Activator ...Gel Separator -SST=Serum separator tube ..(SEROLOGY, SERUM CHEMISTRY  
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show Clot Activator..Gel Separator (SEROLOGY, SERUM CHEMISTRY TESTS)  
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Green Tube   show
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Lavender Tube   show
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Gray Tube   show
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Pink Tube   show
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show Additive: Anticoagulant Sodium Citrate.. Used for:WESTERGREN SEDIMENTATION RATE "4:1 Ratio"  
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show Additive: either no additive, sodium heparin, or EDTA ... Used for trace metal assays "TOXICOLOGY STUDIES"  
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show Additive: anticoagulant Heparin Used for: Lead Testing  
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Yellow Tube   show
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what is HEMATOLOGY   show
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average person has how many liters of blood   show
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show liquid portion-plasma .....Cellular portion-RBC ,WBC, Platelets(thrombocytes)  
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show CBC complete blood count  
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What is Erthrocyte Sedimentation Rate ESR   show
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show Platelet count test...Bleeding time test...PT test (PROTHROMBIN TIME)...aPTT/PTT test  
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What are some specialized Chemistry Areas   show
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show any time of the day  
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show in the morning as soon as the patient wakes up  
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show usually 8-24hrs ..  
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show patients are required to cleanse the urethral area with castile soap and towelette..first portion of urine ..urinate in tiolet then after in cup ..  
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show a 2000mL graduated cylinder  
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show Cardiac arrest...Hemorrhage ...Reflex arteriospasm...infection  
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taking 10ml of blood from a PREMATURE infant leads to a decrease percentage of what blood volume   show
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show Suitable vein cannot be found  
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When is skin puncture inappropriate   show
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show 2.4mm  
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skin puncture size on premature infants are   show
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Swollen areas are avoided for a venipuncture because   show
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If a bone is punctured what may occur   show
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what are the two most commonly used finger sites on adults for a fingerstick   show
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show causes calluses and discomfort  
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What is the CAPILLARY ORDER OF DRAW   show
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show 0.75-1.0mm  
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What is the appropriate depth lancet for this size of infant: 2-3 kg (4.4-6.6 lbs.)   show
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What is the appropriate depth lancet for this size of infant: 3 kg (6.6 lbs.) or greater   show
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What is the use of EMLA   show
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show blood leaks from vein or capillaries and collects in tissues around puncture site  
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Removal of tourniquet AFTER removal of needle can cause   show
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What is PETECHIAE   show
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show Possible latex allergy  
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Who should you contact if bleeding does not stop after 5min   show
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Excessive bleeding can be due to what type of anticoagulants   show
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Mastectomy patients are highly susceptible to ..?   show
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In Mastectomy patients, due to edema some tests may be   show
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show back of hands, legs, or a fingerstick (consult physician first)  
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Edema   show
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The heart is the size of a ..... ??   show
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show 60-80 times/min  
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What is the SEPTUM   show
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what is the Pericardium   show
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show the Superior and Inferior Vena Cava  
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the LEFT ATRIUM filles with blood from the   show
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show Ventricles  
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the left and right atria are separated by   show
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show ATRIA  
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Contracitons of the heart pushes what out   show
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show Pulmonary artery  
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show the interventricular septum  
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Sinoatrial (SA)node "pacemaker" causes ?   show
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What is the function of the ATRIOVENTRICULAR (AV)Node   show
🗑
show Relaxation phase of the cardiac cycle (VENTRICLES ARE FILLING WITH BLOOD FROM THE ATRIA)  
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show Contraction phase of cardiac cycle (VENTRICLES CONTRACT AND PUSH BLOOD THROUGH PULMONARY VALVE AND AORTIC VALVE TO DISTRIBUTE BLOOD TO LUNGS AND BODY)  
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The heart is controlled by   show
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Bradycardia is considered at what heart rate   show
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Tachycardia is considered at what heart rate   show
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show Thick outer layer, mostly connective tissue (prevents rupture or bursting due to increased pressure)  
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Tunica Media is   show
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show Inner layer, single later of endothelial cells, connetive tissue, and elastic fibers (smoothness prevents abnormal blood clotting)  
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Adult men have about how much blood   show
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show 4-5 liters of blood  
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show 2.8(55%) of plasma and 1.9 liters (45%) of cells  
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show 90% water and 10% solid materials  
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Serum is composed of   show
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show Dark green/yellow  
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What color is HEMOLYZED (liquid component)   show
🗑
show Milky/creamy/cloudy  
🗑
Erthrocytes have a life spam of   show
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Neutrophils are   show
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show Bright RED/ORANGE cytoplasmic granules with a BILOBED NUCLEUS.. they INCREASE IN ALLERGIC REACTIONS AND PARASITIC INFECTIONS "0-5% percentage in the body"  
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Basophils are   show
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show Non-granular blue cytoplasm...LIGHT BRIGHT PURPLE NUCLEUS..2types T-destroy foreign material..B-produce antibodies to fight infection "20-40% in the body"  
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show Non-granular cytoplasm...KIDNEY BEANED SHAPED..PURPLE NUCLEUS ....phagocyte and becomes macrophage ...it is the LARGEST WBC ..."4-10% in the body"  
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What is the function of a THROMBOCYTE   show
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what is an antibody   show
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RBCs with A antigen =   show
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RBCs with B antigen =   show
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RBCs with A and B antigen =   show
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RBCs without A or B antigen =   show
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show Rh+  
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show Rh-  
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show neglect or failure to perform an obligation  
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show Rights that every patients has while undergoing treatment  
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show the period after the incident that a patient has to file a lawsuit (may begin after the problem is discovered)  
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define TORT   show
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show The ordinary skill and care that medical practitioners such as physicians, nurses and phlebotomists must use that is commonly used by other medical practitioners when caring for patients  
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show Failure to perform professional duties in accepted standard of care  
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deinfe Proximate cause   show
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show Latin phrase that means “the thing speaks for itself” • This is a doctrine of negligence law  
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define Respondeat superior   show
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show Legislative, executive, and judicial  
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what are the three levels of law   show
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what is negligence   show
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what is MALPRACTICE   show
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show – Duty – Derelict – Direct Cause – Damage  
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If a phlebotomist becomes infected with HIV during employment, he/she will be covered by   show
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show • Health Insurance Portability and Accountability • Protects the privacy and security of a person’s health information when that information  
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In order for a provider to use or disclose PHI, the hospital/lab must give each patient a   show
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show Waived (level I)....Moderate (level II)...High (level III)  
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show • Simple testing that requires minimum judgment or interpretation • Incorrect test results pose little risk for the patient • Examples – Dipstick urinalysis – Pregnancy testing  
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show • Moderate complexity of testing • 75% of all lab tests • Certified by approved accrediting agency • Requires MLT or higher discipline • Must meet quality assurance standards  
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What is HIGH (level III)   show
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Most frequent reason for rejection in hematology is   show
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show 4hrs at room temperature and 12hrs refrigerated  
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What is MINOR MISLABELING   show
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what is MAJOR MISLABELING   show
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56% of lab errors occur during what phase   show
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show Improper patient identification  
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An impatient should be asked to state his/her name, address, DOB and or unique ID number according to whos standards   show
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Fasting specimens should be collected around how many hours?   show
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How long do you pre-warm a site for capillary collection   show
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show CLSI  
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show you result with RBC SHRINKAGE  
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What happens if you under-fill blue top tubes   show
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show -BILIRUBIN -CAROTENE  
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aPTT should be tested within...?   show
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show 48 HOURS (at room temperature)  
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show ENDOCARDITIS  
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Why are blood cultures done?   show
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show Physician might put the patient on broad-spectrum antibiotics, OFTEN I.V.  
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Septicemia may cause...?   show
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show CONTAMINANTS  
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show Organisms come from infected organs, cavities, fluids (CSF, synovial fluid, pericardial fluid), untreated superficial wounds, abscesses, U.T.I., or Respiratory infections  
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show Vascualr access devides(atrial lines, central venous catheters, etc.) urinary catheters, needles, etc  
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Define TRANSIENT BACTEREMIA   show
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High risk contamination rates are an example of   show
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show Swelling ...an accumuation of fluid in the intercellular spaces of the body (FLUID IS INTRACELLULAR)  
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show (Bruise) ..Caused by the leakage of blood from veins and capillaries that collects the tissues (Blood accumulation)  
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show REMOVAL OF LYMPH NODES (high susceptibility to infections)  
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Sclerosed Veins   show
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If both arms have an IV, obtain the blood specimen ....?   show
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PKU tests are done to..?   show
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If BILIRUBIN levels are too high babies are placed on...?   show
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show ISOLETTE  
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Newborns are extremely susceptible to ...?   show
🗑
show LANCETS  
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show DERMAL  
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show Children under 1year/20pounds  
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Finger punctures are considered for   show
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show VENIPUNCTURE  
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show LATROGENIC ANEMIA  
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show 40dB  
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Dialysis is performed on patients with   show
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show Waste products are removed from the blood  
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Venipunctures are prohibited from dialysis patients therefore you must perform..?   show
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How many identifiers is recommended for an outpatient?   show
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show OSHA  
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show 3-4inches (restricts bloods flow, causes veins to distend)  
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Why should you allow chlorhexidine to dry completely before beginning a venipuncture   show
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show 15-30 Degree angle (BEVEL UP)  
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All tubes with additives must be properly mixed as quickly as possible to prevent...?   show
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Examples of special handeling regarding "KEPT COLD SPECIMEN" include:   show
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Examples of special handeling regarding "KEPT WARM SPECIMEN" include:   show
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Examples of special handeling regarding "KEPT IN THE DARK SPECIMEN" include   show
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show Syncope...Nausea...Vomiting  
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show PHYSICIAN  
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What are some communication strategies   show
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show -THE SENDER(Person sending the message) -MESSAGE SENT(What the sender wants to convey) -SYMBOLS(How the sender communicates the message) -MESSAGE RECEIVED(How the message is perceived)  
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What is the measurement considered for "PERSONAL SPACE"   show
🗑
What is the measurement considered for "SOCIAL SPACE"   show
🗑
show >12ft. (lectures, speeches)  
🗑
show Area around patient that is private territory(CHILDREN may feel uncomfortable if you get to close)  
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What is the "GOLDEN RULE"   show
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What is "Culture Sensitivity"   show
🗑
show -Hypertension -Hyperglycemia -Stroke -Myocardial Infarction -Diabetes -Ulcers -Neck and back pain  
🗑
show Headaches/fatigue (due to burnout and overload)  
🗑
Immediate physical signs of stress are?   show
🗑
What are some coping strategies for stress   show
🗑
define ethics   show
🗑
define accountability   show
🗑
Define Hemophilia   show
🗑
show tendency to clot  
🗑
show Process of blood clotting and then the subsequent dissolution of the clot following repair of injured tissue  
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What are the 5 Steps of the hemostatic process   show
🗑
What is Primary Hemostasis   show
🗑
show "tightening" of blood vessels to divert blood flow around the damaged vessel -enhances contact activation of platelets and coagulation factors  
🗑
Define Platelet Adhesion( Platelet Phase)   show
🗑
show Stabilizes the initially loose platelet plug, a sequence of enzymatic reaction is initiated which culminates in fibrin strands forming at the platelet plug  
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show -Coagulation factors interact with each other to form a fibrin clot (reinforces the platelet plug...ADP, thromboxon, PFB) "FIBRIN FORMING SYSTEM  
🗑
What are "Coagulation Factors"   show
🗑
show Activated when endothelial cells are injured and tissue factor is released -activated factor VII and tissue factor bind to form a complex.(this complex, plus calcium, activates factor XTissue Factor)  
🗑
show Initiation occurs when factor XII is exposed to a negatively charged surface(termed the contact phase) "REQUIRES CLOTTING FACTORS VIII-XII  
🗑
show When factor Xa bigs to the platelet surface, a complex is formed composed of platelet phospholipid, calcium and factor Va...-Complex converts prothrombin to thrombin which in turn converts fibrinogen to fibrin  
🗑
Explain Fibrinolysis   show
🗑
Thromboplastin activates what factor?   show
🗑
show Balance between coagulation and fibrinolyctic process must be maintained otherwise excess clotting or fibrinolysis will occur  
🗑
Thrombophilia causes what   show
🗑
show Hypercoagulable state due to inherited(heriditary/genetic) defects or acquired defects in one or several factors of the coagulation cascade  
🗑
show Total absense of measurable fibrinogen (RARE CONGENITAL DISORDER)  
🗑
show Below normal levels of fibrinogen -treated by cryoprecipitate or FFP  
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FACTOR 1(fibrinogen)...define DYSFIBRINOGENEMIA   show
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explain ...FACTOR V (proaccelerin)GENE DEFECT   show
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what does MTHFR do ?   show
🗑
deficiency of MTHFR causes ?   show
🗑
Acquired Homo cysteine is due to   show
🗑
show keeps on activating thrombin to convert fibrinogen into a fibrin clot  
🗑
show vonWillebrand's Disease  
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Defect or absense of coagulant portion causes   show
🗑
show Increase in inflammation, stress, pregnancy and infectin which can lead to clot formation  
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What is the purpose of Quality Assurance   show
🗑
show QUALITY IMPROVEMENT QUALITY ASSESSMENT PROFICIENCY IMPROVEMENT PERFORMANCE IMPROVEMENT  
🗑
define T.A.T.   show
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What is the purpose of P.I.   show
🗑
What is the overall goal of P.I.   show
🗑
Where does P.I. begin in a hospital setting   show
🗑
show Logs examined in quality assurance meeting to determine problem areas (also document problem areas with incident reports)  
🗑
Define INCIDENT REPORTS   show
🗑
What is the purpose of incident reports   show
🗑
Define DELTA TEST   show
🗑
show Containcs information that lists the name of each test/procedure (useful to aid in consistency of testing for quality control purposes "AKA PROCEDURE, REFERENCE or TEST MANUAL)  
🗑
what does JCAHO stand for   show
🗑
show Establishes guidelines for healthcare agencies regarding quality of care  
🗑
What is CQI   show
🗑
What does CQI do ?   show
🗑
What is the ultimate goal for CQI   show
🗑
what are the "Poor patient outcomes (5 D's)"   show
🗑
show Plan-Do-Check-Act  
🗑
What is the purpose of PDCA   show
🗑
What is the primary goal during a specimen collection   show
🗑
show 1970 by US Congress  
🗑
show Assures every working person in the nation a safe and healthful working condition  
🗑
show Universal Precautions (OSHA enforces them)  
🗑
show Microorganisms that cause disease in humans and are transmitted only through contact with infectious body fluids (NOT urine or feces..unless blood is visible) examples:HIV/AID, malaria, syphilis, ebola virus  
🗑
show Jaundice (other symptoms may be ..fatigue abdominal pain, anorexia, nausea and vomiting)  
🗑
show 3 shots over 6month period  
🗑
show Hepatitis C  
🗑
What are the symptoms for Hepatitis C   show
🗑
What are some symptoms for Human Immunodeficiency Virus   show
🗑
Define Prophylaxis   show
🗑
Highest number of phlebotomy injuries occur with ?   show
🗑
What does the bacteriology dept. do   show
🗑
What is Mycology   show
🗑
What is Virology   show
🗑
show The study antigens and antibodies in serum (red top tubes, may base use as well for the detection of an antigen-antibody reaction)  
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show The study of immune process and immunity (immunology lab IDs antibodies that are produced due to a disease state)  
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show Meant to break chain of infection  
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define asepsis   show
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What does fire need in order to start   show
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show Class A,B,C,D  
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What is Class A based on the "category of fires"   show
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show Flammable solvents such as gases, oils, paints, and grease and an interaction with air and vapors  
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What is Class C based on the "category of fires"   show
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show Combustible metals such as lithium and magnesium  
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show For ordinary combustible fires (contains soda and H2o)  
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show For fires from solvents and air-vapor mixtures (contains foam, dry chemical, or CO2)  
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What is the use of Class C FIRE EXTINGUISHERS   show
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show For computer fires  
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What does R.A.C.E. stand for   show
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What does P.A.S.S. stand for   show
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Any chemical that comes into contact with the skin or eyes must be treated   show
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show Detailed information about identity of chemical, physical characteristics, physical hazards and how to handle them, reactivity and dangerous reactions, health hazards, handling precautions and control measure (MUST BE KEPT IN A PROMINENT PLACE)  
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show Chemical Hygiene Plan  
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show Solid, Chemical, Radioactive, Infectious  
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Alcohol can become what type of hazard   show
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Cytotoxic drugs can be what type of hazard   show
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Nitrous Oxide can be what type of hazard   show
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show Carcinogenic irritant  
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Bleach can be what type of hazard   show
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Betadine is what type of hazard   show
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Mercury can be what type of hazard   show
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Glutaraldehyde can be what type of hazard   show
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White out can be become what type of hazard   show
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show Hormones: testosterone, cortisol, adrenocorticotropic hormone (ACTH, iron and insulin  
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show Eosinophil count, creatine, glucose, triglycerides  
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What are some specimens that have to be kept cold during transport   show
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What color will plasma or serum be if there is a leakage of hemoglobin   show
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show CBC..LD..AST..K+..Fe..T4  
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show 8-10times  
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show Takes place during testing the specimen  
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What is post analytic phase   show
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What are the most common fasting specimens   show
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show Screens for Diabetes  
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What is the purpose of a Glucose Tolerance Test   show
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show Diagnoses lactose intolerance  
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what is the purpose of epinephrine tolerance test   show
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What is the purpose of Therapeutic Drug Monitoring (TDM)   show
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Why are blood cultures performed   show
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When is it best to draw a blood culture   show
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show Assesses status of patient's hemostasis (detects platelet function disorders "PART OF STANDARD PRE-SURGICAL WORK UP"  
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Blood smears can be performed using what type of blood?   show
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What is Neonatal Screening? ...   show
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show Monitors patients respiration status (obtaines for measuring Po2, PCO2, and pH of blood..which tells the degree of oxygenation and acid base balance of blood.  
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show ETOH, Drug screening, DNA analysis  
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show at patients bed side (falls under CLIA)  
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show Glucose level, PT, aPTT/PTT,cardiac enzymes (reduces TAT)  
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show Troponin, Amylase, lipase, ABG, BUN, Creatinine , Hct, Hgb, RBC Count  
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What is the duty of College of American Pathologist (CAP)   show
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show Establishes procedural guidelines for all areas of the lab  
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show Accredits agency for hospitals and nursing homes ..inspects every 2 years ..enforces standards established by CLSI ..works with CAP to provide lab accreditation  
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show Ensure quality lab testing  
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show has responsibiliyu of implementing CLIA program  
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