# LEIE / SAM screening log

Authority: 42 CFR 1001.1901. LEIE updates monthly. SAM is complementary, not a substitute.

Laboratory:
Period covered:
Reviewer:
Review date:

| Person or entity | Role (employee / contractor / vendor) | List (LEIE / SAM) | Date screened | Result | Alert disposition | Reviewer | Notes |
| --- | --- | --- | --- | --- | --- | --- | --- |
|  |  |  |  | Clear / Hit |  |  |  |

## Monthly close

- Lists used (version / download date):
- Hits this period:
- Open follow-ups:
- Director or compliance sign-off:

This log is a survey artifact. Do not keep it only in email.