Get Wa Doh 505-026 2019

Filling out the WA DOH 505-026 form is a crucial step for laboratories seeking a Certificate of Waiver for Medical Test Sites. This guide provides user-friendly instructions for completing the form online, ensuring you understand each section and its requirements.

Follow the steps to complete your application accurately.

1. Press the ‘Get Form’ button to access the WA DOH 505-026 application form and open it in your preferred online editor.
2. Begin with Section 1: Demographic Information. Fill in your Uniform Business Identifier (UBI) number, Federal ID number (FEIN), legal owner/operator entity name, mailing address, and contact information for both the owner and facility.
3. In Section 2: Facility Specific Information, select the applicable site type from the options provided and indicate if there are additional locations under this license.
4. Proceed to Section 3: Key Individuals. Enter the names, professional license numbers, and email addresses of the Lab Director and Lab Contact Person.
5. In Section 4: Additional Information—Waived Tests, check the boxes next to all waived tests performed at your facility. If you perform tests other than the waived tests listed, you will need to refer to additional resources.
6. Complete Section 5: Other Licensure, Certification or Registration Information. Provide detailed information about the legal owners and any change of ownership, if applicable.
7. Finally, in the Signature section, ensure that you sign the form, date it, and print your name and title. Review all entries for accuracy before submission.
8. Save your completed form, and consider downloading or printing a copy for your records. You may then share the form or submit it to the Department of Health along with any required fees.

Complete your application online today to ensure timely processing and compliance.