USCIS to stop accepting the TB skin test

USCIS to stop accepting the TB skin test

Beginning October 1, 2018, the tuberculin skin test (TST) will no longer be accepted for US Citizenship and Immigration Services (USCIS) immigration exams (1). All US civil surgeons must use a TB blood test (interferon-gamma release assay or IGRA) as the initial screening method when a test for cell-mediated immunity to TB is required. This new requirement aligns with current CDC recommendations stating that IGRA testing is strongly preferred for those who are BCG-vaccinated.

Drug Testing Reporting

Drug testing unrelated to the reporting of a work-related injury or illness.
Drug testing under a state workers’ compensation law.
Drug testing under other federal law, such as a U.S. Department of Transportation rule.
Drug testing to evaluate the root cause of a workplace incident that harmed or could have harmed employees. If the employer chooses to use drug testing to investigate the incident, the employer should test all employees whose conduct could have contributed to the incident, not just employees


Lead (Pb) is a naturally occurring chemical metal, and is very stable and accumulates in the environment. The human body absorbs organic and inorganic lead , and exposure to high amounts of lead can be dangerous.
* Impaired Cognitive Ability
* Affected Nervous system /behavioral changes/
* Damaged renal system, anemia, fatigue
* Hearing, speech and developmental milestone
The Center Disease Control and Prevention says “the following groups of kids aged 6 mo and 6 year old should be considered highly priority for lead blood testing”
The U.S. government ruled that lead based paint was no longer allowed for household use. In fact, an estimated 24 million houses have peeling leaded paint and higher than normal level of lead-filled house dust.If there is a chance you or your child has been exposure to lead, a blood test can show how much of the elements in your bloodstream. So if a blood test result show level are hight you have start treatment to get the lead out from your system.
* lead-based paint on the walls, doors and windows
* an environmental and transport mechanism
* lead-contaminated house dust is th major course of exposure from
* Lead occurs in drinking water through leaching from lead-containing pipes, faucets and solders frequently found in the plumbing of older buildings
* Some commercial products
* Some imported jewelry and candies
* Children’s toys
* Cosmetics

Everything a Notary Must Know about an Apostille

Everything a Notary Must Know about an Apostille
According to the Hague Conference on Private International Law, “An apostille is a certificate that authenticates the origin of a public document.” In order for the apostille to be used, both the issuing and receiving countries must be party to the Apostille Convention. Additional information about the Apostille Convention can be found in the publication “ABCs of Apostilles.” In addition, the following link provides a list of countries belonging to the Apostille Convention.
I have clients from all walks of life who require assistance in processing their apostille requests. It is important to note that, as notaries, we are assisting with the processing of the client’s paperwork and sometimes providing courier services. The most common documents that need apostilles are birth certificates, school diplomas and transcripts, power of attorneys, and marriage, birth, and death certificates.
While you don’t have to be a notary public to assist with the apostille process, many documents that require an apostille need to be notarized first, so having a notary commission is a plus if you plan to take on this endeavor.
There are several different variables involved when determining how an apostille request should be processed. There is no way all of the variables can be covered in one article. However, the majority of the documents I’ve processed have been fairly simple and have only required an apostille from the Secretary of States Apostille Unit.
Each state handles the apostille request in a different manner. For instance, some states charge a fee per document. At the time of this writing, Texas charges $15 per document apostille. Indiana, on the other hand, does not charge a fee for apostille documents, while New Mexico charges $3 per apostille.
Texas and New Mexico apostille units usually provide same-day service for walk-ins. Indiana does not guarantee same-day service for walk-ins, and if a person is requesting more than 15 documents at one time, the person will have to drop documents off and return in a day or two for pick up.
Before beginning the apostille process, there are several factors that must be considered:
Type of document: This will determine the approval authority. For example, I had a customer who had a Federal FBI background check that needed an apostille for use in Mexico.  Two things to note here: 1- Federal documents must be apostilled by the U.S. Department of State. 2- Mexico is a party to the Apostille Convention, so there was no authentication required, only the apostille.
Country of destination: Is the document to be used in a Hague or non-Hague country? If the document is being used in a non-Hague country, then it will need to be authenticated, not apostilled. (Additional steps are usually required.)
State from which the document originated: This will determine which state issues the apostille. Apostilles are issued by the originating state. For instance, I had a client who lived in Mexico, and he needed an apostille for his college transcripts to use in Mexico. He attended the University of North Carolina, so transcripts had to be notarized by the university’s registrar and then forwarded to the North Carolina Secretary of State’s Office for a Mexico apostille.
Date of the document: Rules regarding the dating of documents will vary from state to state. For instance, if a Texas resident has a certified copy of a birth certificate with a date that is more than three years old, a new certified copy of the document needs to be requested. Birth certificates requiring an apostille in the state of Texas cannot be more than three years old. You need to know your state’s procedures.
These are just a few of the steps involved in processing requests for an apostille. Check with your Secretary of State’s Office for a more detailed explanation.
— By Phyllis E. Traylor, U.S. Army Retired, Contributing Writer with the American Association of Notaries.

Compliance with New Federal EKRA Law Creates Uncertainties in How Clinical Laboratories Pay Commissions to Their Sales Teams

Vague language and last-minute additions to the federal SUPPORT Act of 2018 with its included EKRA provisions mean big changes to how clinical laboratories can legally compensate sales professionals for referrals
Clinical laboratories may be at grave financial risk should they fail to properly comply with the Eliminating Kickbacks in Recovery Act of 2018 (EKRA) provision of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (H.R. 6, aka, SUPPORT Act).
Labs that compensate their sales staff for referrals to recovery homes (aka, sober living houses) and clinical treatment facilities are particularly vulnerable and should carefully examine the wording in the legislation, legal experts warn.
As Dark Daily reported in “Does New Opioid Law Require Clinical Laboratories to Change How They Pay Sales Employees?,” (April 1, 2019), SUPPORT Act legislation aimed at combating the opioid epidemic could hold dire consequences for how medical laboratories operate due to how it expands oversight over a range of common laboratory practices and workflows.
“For sales-driven laboratories who have evolved practices to comply with Anti-Kickback Statute (AKS) requirements, what are now best practices might soon create major concerns regarding laboratory compliance with EKRA [H.R. 6878],” Marty Barrack, Senior Vice President and General Counsel at XIFIN told Dark Daily.
Stiff Penalties Threaten Clinical Laboratories and Pathology Groups
With fines of up to $200,000, 10 years in jail, or both, the new EKRA/SUPPORT Act regulations—passed in October 2018—apply separately from existing federal anti-kickback statute (AKS) regulations. Compliance violations can expose both the laboratory, pathologists, and other individuals to federal prosecution.
“Because this is a criminal statute, some laboratories overlook the fact that felony convictions mean zero payments. This is more than worrying about federal prosecution, it can have a lasting impact on a laboratory’s financials and its reputation,” noted Barrack. “The provisions regarding invoicing will raise concerns with how clinical laboratories bill and write-off co-payments and deductibles in areas previously untouched by AKS requirements.”
Charles Dunham, Health Law Attorney, Corporate and Regulatory Practice, Epstein Becker and Green, P.C., outlined potential payment arrangement concerns at Health Law Advisor, saying, “… one statutory exemption provides that compensation paid to both W-2 employees and 1099 contractors would not violate EKRA if the payment is not determined by or does not vary by:
  • “the number of individuals referred;
  • “the number of tests or procedures performed; or,
  • “the amount billed or received.”
The National Law Review warns that “With the passage of EKRA, laboratories, clinical treatment facilities, and recovery homes should immediately consider reviewing all financial arrangements with healthcare providers, contractors, and employees who are in a position to generate referrals—including marketing personnel and sales reps.”
They further note, “… Previously compliant payment methodologies structured under the Anti-Kickback Statute’s employment safe harbor (such as paying W-2 employees a volume or value-based commission) are now at risk of violating EKRA.”
Vague Wording in Law Creates Confusion
As covered in the December 3, 2018, issue of The Dark Report, the American Clinical Laboratory Association (ACLA) questions whether—under the new law—laboratories can continue providing phlebotomists or specimen collection devices to physicians’ offices under EKRA. While both scenarios are currently permissible under existing federal AKS regulations, the SUPPORT Act and EKRA do not include language that covers such scenarios.
“Primarily, this language was designed to address potential bad actors working in recovery homes and addiction treatment facilities,” Sharon L. West, Vice President of the ACLA, told The Dark Report. “But then language was added to the bill extending that far beyond treatment facilities to include clinical labs. Now, the new law extends to all payers and all laboratory testing services provided to patients.”
While revisions to or amendment of existing legislation is possible, the terms defined in the existing regulations should concern any medical laboratory offering compensation for the referral of patients for testing.
“The lab industry has some influence to help drive revisions of existing statues. The payer industry also has representation,” Barrack notes. “However, revisions may not proceed as quickly or bring the results some labs expect.”
Understand EKRA and Stay Out of Jail!
It’s critical that all clinical laboratories understand the impact EKRA will have on existing payment agreements, billing practices, and workflows. Non- or incorrect compliance could bring hefty fines—and even jail time!


Total Iron Binding Capacity /TIBC/

Total Iron Binding Capacity /TIBC/

An essential blood test has help indicate a presence of iron deficiency or iron overloading. A health care provider’s are frequently ordered Iron blood test along with Ferritin and Transferrin. Those two tests are so essential to calculate the transferrin saturation. In iron deficiency the iron level becomes low, TIBC is elevated, and transferrin saturation becomes too low. If the iron overloading, the iron level in blood becomes elevated, TIBC is low or normal, and transferrin saturation to increase.


There is no safe level of lead in blood.
Health Effect of Lead Poisoning:
* Impaired Cognitive Ability
* Renal Damage
* Nervous System/behavioral changes
* Anemia, anorexia, tremor
* Hearing, speech and developmental milestone
A blood test can show how much of the element in your bloodstream. Time to testing yourself and your child.

Not all drug addicts smoke pod


Not all drug addicts smoke pot
Of course many do, but marijuana accounts for only 43% of all positive drug tests.
57% are other substances. Drug use in the workplace poses a serious risk to employee safety and productivity.
Employers are obligated to provide a safe and healthy environment for employees.
We provide quick results for drug and alcohol testing. No one gets you results faster.

Apple Cider

An apple cider vinegar contains acids and bacterial cultures that are good for digestive system, and preventing UTI’s, and lowering cholesterol and glucose levels, and it can be aid to weight loss.

Drug Tests


Drug testing unrelated to the reporting of a work-related injury or illness.
Drug testing under a state workers’ compensation law.
Drug testing under other federal law, such as a U.S. Department of Transportation rule.
Drug testing to evaluate the root cause of a workplace incident that harmed or could have harmed employees. If the employer chooses to use drug testing to investigate the incident, the employer should test all employees whose conduct could have contributed to the incident, not just employees


The LiveScanLabs provides the essential Toxic & Essential Elements Profile contains an extended a Line up of toxic metals. This Profile provides important information about your health conditional which can assist to a doctor with an early diagnosis. For instance,
Nickel (Ni) is essential element which is required extremely low amounts, and excess of Nickel (Ni) has been established to be nephrotoxic, and carcinogenic.
Elevated Ni is often found in individuals who works in
* electronic and plating
* mining
* steel manufactured industries.
A cigarette contains 2-6 mcg of Ni, and Ni absorbed more efficiently in lungs than in a gastrointestinal tract.
Symptoms of chronic exposure include:
* chronic rhinitis,
* dermatitis,
* hypersensitivity reactions,
* hyper sensitize the immune system , subsequently sousing hyper allergic responses to many different substances.
Long term or chronic Ni toxicity may lead to
* liver necrosis
* carcinoma


To make one such drink, you will need 8 glasses of water, 1 spoon of grated ginger, 1 medium-sized fresh cucumber, peeled and cut into thin pieces, 1 medium-sized lemon cut into pieces, 12 leaves of mint. You will first have to mix the indicated ingredients with water. Leave the mixture during the night so that the ingredients can discharge their aromas, so consume it during the following day. Whenever you’re thirsty, just have this drink. At least for 4 days, prepare fresh water every day and you won’t miss the result.
Sometimes a simple drink can refresh you the most and also help reduce the fat deposits accumulated on the key spots of your body.


Stem cells have the potential to replace cell tissue that has been damaged or destroyed by severe illness. Stem cells can be used to generate healthy and functioning specialized cells which can then replace diseased or dysfunctional cells.

Stem cells therapy can treat any disease where there is tissue degeneration.

Cell replacement therapy could treat injuries and various genetic and degenerative conditions, such as:

  • Retinal degeneration
  • Alzheimer’s disease
  • Parkinson’s disease
  • Muscular dystrophies
  • Arthritis
  • Diabetes
  • Spinal cord injuries
  • Blood disorders
  • Many More

Why Are My Drug Test Results Taking So Long?


As good as we are at responding to our clients’ requests, there are some things you cannot rush.

The majority of negative test results are delivered within 24-48 hours of collection.

Here is how positive drug test results work.

If a drug tests positive on the initial screening test, then the lab performs a more thorough test (usually GC/MS), usually the following day. If it fails that test the result goes to the MRO for review.

MRO calls donor to ask for explanation.

If the donor is contacted immediately and the MRO has all s/he needs, the result is released. Total time can be as little as 3 or 4 business days.

For DOT tests, our MRO tries to reach the donor 3 times within 24 hours. If no contact, they let us know and we’ll ask you to have him/her contact the MRO. At that point, if they don’t hear from him, they release results in 72 hours. Technically they are supposed to give him 10 days though, so some circumstances may extend the process.

For non-DOT tests, the MRO tries to reach the donor once and give him/her 24 hours to respond. If no response, they release the result as a “non-contact positive.”

If there is a conversation between MRO and donor, and donor has no satisfactory explanation, result is released as positive.

If there is an explanation (e.g. a prescription), then the MRO releases it accordingly.

For DOT tests, the lab and MRO are not allowed to tell us anything until it’s complete.

These things can take anywhere from 2 days to more than a week, depending on whether the MRO can reach the donor right away. If a prescription is involved, the donor is given time to provide it.

New for 2018: If the donor provides a valid prescription, the MRO is required to release a negative result. If there is a possible safety concern, the MRO will ask that the donor be switched to a safer medication. If that is not done, or not possible, the MRO may revise the negative result to be “negative with a safety concern.”

We all wish the process were faster, but the system is designed to protect the donor’s privacy in the case of a prescription, and to protect the rest of us from liability in those cases as well.

Lastly, don’t assume a slow result will come back positive. Sometimes they come back negative. Wait till you know for sure.


Think of the circulatory system as the highway of the red blood cells.  Red blood cells carry oxygen to the target tissues for nutrition and take away the carbon dioxide for garbage.  It can be a rough ride down the pathways if there are potholes on the road or if there is heavy traffic along the route.  Turbulence harms the fragile red blood cells, much like it would likely cause damage to your vehicle.   Blood vessels compose our circulatory system and are burdened by damage caused by cholesterol plaques, smoking, excessive sugar consumption, etc.  These insults cause inflammation and fibrosis leading to the breakdown of a smooth ride for the oxygenated red blood cells.

Our bodies are built with internal mechanisms to help heal the damage caused by daily life, bad choices and genetic consequences.  Growth factors are naturally secreted from blood components called platelets that are important to repair, wound healing, and growth.  Although many growth factors exhibit angiogenic activity, most evidence points to a special role for Vascular endothelial growth factors (VEGF), also called vascular permeability factor, that promote blood vessel formation in early development (vaculogenesis) and have a central role in the growth of new blood vessels (angiogenesis)¹.

Low-intensity extracorporal shock wave (LI-ESWT) causes a sort of “microtrauma” to the tissues which then release angiogenic factors such as nitric oxide synthase and VEGF and also causes the release of endothelial cell proliferation factors such as proliferating cell nuclear antigen.  Studies show that LI-ESWT, like RegenerWave™, elevates the angiogenic marker levels within a few days post-therapy and the levels remain high for almost 2 months²!  This is important to understand in the treatment of vasculogenic erectile dysfunction.  Kalyvianakis, a leading researcher in the use of LI-ESWT for ED, demonstrated the significant improvements of penile hemodynamics after a 9 week trial of 12 sessions³.  Thanks to all of this data, RegenerWave™ will soon become your first choice to treat Erectile Dysfunction.

  1.  Cotran, R.  Robbins Pathologic Basis of Disease.  6th edition.  1999.
  2. Wang, C.  Shock wave therapy induces neovascularization at the tendon-bone junction.  A study in rabbits.  Journal of Orthopaedic Research.  2003; 21:984-989.
  3. Kalyvianakis D.  Low-Intensity Shockwave Therapy Improved Hemodynamic Parameters in Patients With Vasculogenic Erectile Dysfunction:  A Triplex Ultrasonography-Based Sham-Controlled Trial.  The Journal of Sexual Medicine. 2017; 14: 891-897.

Hormone Testing

Hormone Testing The Basics and Your Body

Almost all people around the ages of 30-40 begin to experience hormone imbalance. Over our lifetime, we are exposed to environmental and dietary toxins, which contribute to the natural decline of hormones as we age. These Hormones are responsible for a whole host of activity which help keep the body youthful as longevity and quality of life are the main goals. As a result of hormone imbalance you may be experiencing one or a combination of what have become known as the classic symptoms of aging:

  • Weight gain  – Mood swings  – Low Sex Drive  – Weight Gain  – Depression  – Fatigue –  Sexual Dysfunction  – Memory Loss  – Poor Sleeping  – General Fatigue

Lets take a quick look at the One Lab Hormone Panel which includes:

  • DHEA-S  – TSH  – FSH  – Estradiol – Progesterone  – T3 Free & Total   – T4 Free & Total
  • Testosterone Free & Total  – Homocysteine  – Prolactin

Why wait till things get worse come into ONE LAB for quick testing only 24-72 hours for your results. Hormone replacement isn’t a one-size-fits-all but a custom plan for your individual needs. Lets look at a quick overview of what these hormones do and why they are so important.


DHEA-S Dehydroepiandrosterone is a hormone produced by both men and women and deficiency can include: prolonged fatigue. poor concentration. a diminished sense of well-being.


TSH thyroid stimulating hormone is a pituitary hormone that stimulates the thyroid gland which stimulates the metabolism of almost every tissue in the body.

FSH Follicle-stimulating hormone is a gonadotropin and is synthesized and secreted by cells of the anterior pituitary gland and regulates the development growth, pubertal maturation, and the reproductive process.

Estradiol is used in menopausal women to help treat hot flashes and prevent osteoporosis. It also helps with low estrogen levels.

Progesterone has a variety of important functions in the body. It is also a crucial metabolic intermediate in the production of other endogenous steroids, including the sex hormones and the corticosteroids, and plays an important role in brain function as a neurosteroid.

T3/T4 thyroid hormones are hormones produced by the thyroid gland that are primarily responsible for regulation of metabolism.

Testosterone is the primary male sex hormone and an anabolic steroid. In males, Testosterone plays a important and primary role for reproductive tissues such as the testes and prostate along with secondary characteristics muscle and bone mass, growth of body hair. Testosterone also is involved in overall health and well-being, studies show it helps prevent osteoporosis with low levels causing bone loss.

Homocysteine is a naturally occurring amino acid found in blood plasma. High levels of homocysteine in the blood are believed to increase the chance of heart disease, stroke, Alzheimer’s disease, and osteoporosis.

Prolactin is secreted from the pituitary gland in response to eating, mating, estrogen treatment, ovulation and nursing. Prolactin is secreted in pulses in between these events. Prolactin plays an essential role in metabolism, regulation of the immune system and pancreatic development.