Get Change Of Information/addition Of Test Form: Exempt ... - Health Nv

This guide provides clear and supportive instructions for completing the CHANGE OF INFORMATION/ADDITION OF TEST FORM: EXEMPT ... - Health Nv. Whether you are updating your information or adding tests, following these steps will ensure a smooth and efficient process.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Review the form to ensure you have the necessary information on hand. Begin by checking the applicable laboratory type at the top of the form, selecting either exempt, registered, or licensed laboratory.
3. Indicate the type of change you are making by checking all relevant boxes. Remember, submitting the form entails a $300 fee for specific changes like director, location, name, or addition of tests.
4. In Section 1, input your current information in the provided boxes. This includes your laboratory or business name, Doing Business As (DBA) name, contact details, and address information.
5. In Section 2, enter the changes you wish to make. Make sure to fill out all relevant fields, including updated contact information, address, and any added tests.
6. If you are solely modifying your email, phone, hours of operation, fax number, mailing address, or contact person, you may fax the form without a fee directly to the medical laboratory unit.
7. Ensure the director's signature is notarized on the form. A photocopy or a signature stamp will not be acceptable.
8. After completing the form, submit it along with a $300 fee, if applicable, via personal check, cashier's check, or money order made out to the Nevada State Treasurer.
9. Lastly, send the completed form, along with all required documentation, to the Division of Public and Behavioral Health, Medical Laboratory Services, at the provided address. Allow 30 days for processing.

Take the necessary steps to complete and submit your form online today!