Get Initial Laboratory Bpermit Applicationb - Wadsworth Center - Wadsworth

Filling out the Initial Laboratory Permit Application can be straightforward with the right guidance. This guide provides step-by-step instructions to help you complete the application process efficiently and accurately.

Follow the steps to successfully fill out the Initial Laboratory Permit Application.

1. Click ‘Get Form’ button to obtain the application form and open it in the online editor.
2. Begin with the contact information. Provide the name of the contact person and their telephone number and email address. Ensure this information is accurate for any correspondence.
3. Complete the general laboratory information section. Enter the laboratory's name (limit to 70 characters), federal employer ID number, address, county, email address, city/town/village, state, ZIP code, and laboratory telephone and fax numbers. Indicate if the laboratory is a small business.
4. In the ownership information section, select the type of ownership (individual, partnership, corporation, government, etc.) and provide the owner’s name and address. List all individuals with ownership interests as required.
5. Indicate the facility type by selecting from the options provided, ensuring it accurately represents your laboratory's operations.
6. If applicable, fill out the section on other approvals, including any CLIA numbers and Medicaid provider IDs.
7. Proceed to provide additional information about operations, including any service centers, mobile courier services, or other health service providers that share the same location.
8. Document the laboratory testing details. Describe the laboratory facility, ensure the space is contiguous, and provide the square footage. Attach your test offerings as required.
9. List the laboratory director's details and qualifications, ensuring the doctor holds a New York State Certificate of Qualification. Specify on-site availability and other employment details.
10. Complete the assistant director details in a similar manner as the director, while also indicating their qualifications and on-site availability.
11. Specify the categories or subcategories for which you seek a laboratory permit, including the responsibilities of directors or assistant directors.
12. In the certification section, review all documents and laws as required. Sign and date the application, including signatures for the director, owner, and any assistant directors.
13. Submit your application along with the registration and inspection fee. Review your application one last time to ensure all fields are filled accurately before final submission.

Start completing your laboratory permit application online today for a seamless submission process.