CLIS Clinical Laboratory/Blood Bank User Registration

Please enter the following information to submit your new user registration.  Do NOT use this system for existing laboratory/blood bank licenses.  For access to an existing laboratory or blood bank license, please contact CLIS at ALISHelpDesk@doh.nj.gov and instructions will be provided.
Laboratory or Blood Bank Name: ✱
Laboratory or Blood Bank Registered Business (DBA) Name: ✱
9e294aae093e4bfc9ae90e80a51665bd Not applicable 
What type of license will you be applying for? ✱
Personal Information:
Please list the address of the laboratory/blood bank.
User Confidentiality Statement ✱
User Confidentiality Statement

NJDOH is committed to protecting the privacy and security of individual identifiable health information of a confidential nature.  Information pertaining to patients and other sensitive information must be held in strict confidence.  This agreement must be completed and signed by each individual/provider requesting access to NJDOH's Blood Bank and Clinical Laboratory Licensing system.

User Confidentiality Agreement

I have read and understand this agreement and the obligations and responsibilities listed below. I agree that:

  1. I shall keep strictly confidential all information, in any format, that I receive or have access to as an authorized user of the NJDOH CLIS Licensing system (ALiS).
  2. I shall keep my password secure and will not permit use of my access privileges or password to any other person or entity.
  3. I will only access ALiS to retrieve or submit information and to generate documentation in the office course of my duties and responsibilities.
  4. I will not divulge, disclose, use, transfer, remove or otherwise furnish personally identifiable information obtained from ALiS to any individual or organization for any use not authorized by the NJDOH or directly involved with the conduct of my official duties as they relate to Blood Bank and Clinical Laboratory Licensure.
  5. I will not copy all or part of the database or software used to access the ALiS system.
  6. I understand the NJDOH may audit any record, electronic or written, that is part of the ALiS system, or pertains to the information entered by an authorized user.
  7. I agree to immediately report any breach of confidentiality to the NJDOH CLIS Team.
  8. I understand that any violation of the above provisions may result in a termination of user privileges, disciplinary action, and the imposition of any and all penalties as prescribed by applicable State and Federal laws.

I have read, acknowledge, and agree to abide by the User Confidentiality Agreement for access to the NJDOH ALiS system.  I will ensure that I and my employees/agents/assignees granted access privileges adhere to the confidentiality provisions above in performance of their official duties.  I will promptly notify the CLIS Team to deactivate their access privileges when an authorized user departs my practice/organization in order to maintain system security.

9e294aae093e4bfc9ae90e80a51665bd I have read the above confidentiality requirements and agree to the terms of service.