Organization Profile Form

Medical Laboratory Scientist MLS (AMT)
Organization Profile
Organization Name*
Organization Type*

UniversityOther
High School Affiliate
Name of Partnered Organization
Campus Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name*

First NameLast Name
Title*
Business Email*
example@example.com
Phone Number*
Website Address and/or Academic Program Links*
Accreditor (check all that apply)*

ABHESACCETACCSCACICSCAAHEPNAACLSOther
Accreditor
(If other)
Current Certification Agency Used (check all that apply)*

AMTASCPNoneOther
Current certification agency used
(if other)
Program Curriculum
Does the program award a Bachelor Degree?*

YesNo
Does the program include laboratory experience as part of the curriculum?*

YesNo
Minimum Program Requirements

Check all areas below which apply to your curriculum
General

Laboratory qualityLaws and regulationsSafetyInstrumentation, maintenance, principals of operationLaboratory mathematicsGeneral microscopyPhlebotomy and specimen collectionPatient identificationWaived testing
Chemistry

General knowledgeInstrumentation: Parts, operation, maintenanceRenal function testsHepatic function testsCarbohydrate metabolism testsProtein analysisEnzymologyLipidsWater and electrolytesAcid-base balanceOther chemistry proceduresSpecimen integrity/handling
Immunology and Serology

General knowledgeAnalytic proceduresSerological tests/syphilisSpecial procedures
Immunohematology

General knowledgeImmunoglobulinSoluble componentsCytokinesCompatibility testing principles and proceduresBlood typing
Blood Banking

General knowledgeBlood banking practices
Bacteriology

General knowledgeMedia quality control, techniques and culturesBacterial identificationSpecial tests
Parasitology

General knowledgeParasite identificationSpecial tests
Hematology

General knowledgeErythrocyte proceduresLeukocyte proceduresThrombocyte proceduresSpecial proceduresAutomated instrumentation
Coagulation and Hemostasis

TerminologyCoagulation procedures
Mycology

General knowledgeMycological identificationsMycological procedures
Urinalysis

General knowledgeSpecimen CollectionSpecimen handling/preservationRenal functionUrinalysis proceduresSpecial tests
Total Program Requirements Selected
Agreement*

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example@example.com
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Medical Laboratory Scientist MLS (AMT)

Organization Profile

Program Curriculum

Minimum Program Requirements