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Although clinical symptoms should receive more weight in diagnosing B12 deficiency, the panelists recognized the need to use serum vitamin B12 concentrations as a cost-effective screening marker and the need to additionally measure a metabolic marker to support the diagnosis

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Final Action: After consideration of public comments, we are finalizing, effective January 1, 2026, our proposal to supplant the existing affirmation requirement with the proposed attestation statement at new 180.50(a)(3)(iii), with a modification to add the following phrase to the beginning of the attestation: To the best of its knowledge and belief,