I. LICENSE OR CERTIFICATE Type Number D I R M E I C C T R O O H M U N M H Include copy of license or certificate for each person. THIS FORM MAY BE PHOTOCOPIED LAB 116 OS 7/07 C E A O P Y T M H M H M R L H M H S G.
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How to fill out the Lab 116 online
Filling out the Lab 116 form is an essential step for out-of-state laboratories to report their personnel to the California Department of Public Health. This guide will walk you through each section of the form to ensure that you complete it accurately and efficiently.
Follow the steps to complete the Lab 116 form online.
- Click 'Get Form' button to access the Lab 116 document and open it in the designated online editor.
- Begin by entering the laboratory name in the designated field at the top of the form.
- Input the CLIA number, which is crucial for identifying the laboratory's compliance status.
- Provide the laboratory address, including the number and street name, city, state, and ZIP code.
- Fill in the contact person's name, and include their telephone number in the specified format.
- List all personnel in the appropriate sections. Include the last name, first name, and middle initial, in the spaces provided.
- For each individual listed, specify the type of license or certificate by selecting the corresponding option and entering the number.
- Indicate the complexity of tests performed by marking 'M' for moderate complexity and 'H' for high complexity tests next to each personnel listed.
- Ensure that you have included a copy of the license or certificate for each person listed in the report.
- Once you have completed all sections of the form, review your entries for accuracy. You can then save changes, download the document, print it, or share it as necessary.
Complete your Lab 116 form online now to streamline your reporting process.
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