Get Doh 4081ms 2020-2025

Filling out the Doh 4081ms is a crucial step for laboratories seeking registration with the New York State Department of Health. This guide will provide you with a clear, step-by-step approach to ensure your application is completed accurately and efficiently.

Follow the steps to fill out the Doh 4081ms online.

1. Click the ‘Get Form’ button to obtain the form and access it in the online editor.
2. Identify your CLIA status. If your laboratory already has a CLIA number, enter it in the designated field. Choose between single-site registration and multi-site registration options as applicable.
3. Provide general information about your laboratory, including the laboratory name (limited to 70 characters), the county or borough, physical location address, city, and ZIP code. If the mailing address differs from the physical location, fill that out as well.
4. Specify the contact information, including the name of the contact person if they are not the laboratory director, as well as the laboratory email address, telephone number, and fax number.
5. Indicate the days and hours when testing will be performed. Clarify hours in AM and PM format.
6. Select the type of limited service laboratory that best describes your facility from the provided list. This helps categorize your laboratory based on service type.
7. List ownership information, including the name and address of the individual or entity owning the laboratory. Indicate the type of ownership (for-profit, not-for-profit, or government).
8. If applicable, provide details of any affiliation with another laboratory holding a New York State laboratory permit, including PFI number and address.
9. If testing is provided under a management contract, include the name and address of the management company.
10. Complete the laboratory directorship section, providing the name and qualifications of the individual directing laboratory testing.
11. Check off all waived tests and provider-performed microscopy procedures that you intend to perform. Provide the estimated annual test volumes for these tests.
12. Review your application to ensure all fields are completed and accurate. Make sure to sign and date where indicated, both by the laboratory director and the person completing the form.
13. Once all information is filled out, proceed to save changes, download, print, or share the completed form as needed.

Start completing the Doh 4081ms online today and ensure your laboratory is registered successfully.