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How to fill out the Lab 155 online
Completing the Lab 155 application for initial clinical laboratory registration is a crucial step for ensuring compliance within the state of California. This guide will provide you with clear instructions on how to effectively fill out this form online, ensuring that you meet all necessary requirements.
Follow the steps to successfully complete your Lab 155 application.
- Press the ‘Get Form’ button to access the Lab 155 application form and open it in your preferred document editor.
- Select one of the registration options: either register for state oversight or choose deemed status with an approved accrediting organization. If you choose deemed status, be prepared to upload a copy of your current accreditation certificate.
- Fill in the basic information: provide the name of your laboratory, tax identification number, complete address (including city, county, and zip code), telephone and fax numbers, and email address.
- Enter the CLIA provider number associated with your laboratory.
- Complete the legal name of the corporation, district, or association owning the laboratory. If using a fictitious name, ensure the relevant permit is filed.
- Select the type of ownership. Check the appropriate box and furnish the names and addresses of the ownership structure, whether it is a corporation, partnership, unincorporated association, or other.
- List the names and addresses of laboratory directors, specifying if they are an M.D. or D.O. Include the number of hours they will be on site per week.
- Ensure the application is signed by both the laboratory director and the owner or authorized signatory, including their printed names, titles, and dates of signature.
- After completing the form, you may save your changes, download the document, print it, or share it as needed before submitting to the California Department of Public Health.
Complete your Lab 155 application online today to ensure your laboratory is registered and compliant.
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