Get Lab 144

Filling out the Lab 144 application for initial clinical laboratory license is an important process for laboratories seeking state oversight or deemed status in California. This guide provides clear, step-by-step instructions to help you complete the form accurately.

Follow the steps to successfully complete your Lab 144 application.

1. Press the ‘Get Form’ button to access the Lab 144 application and open the document in your browser.
2. Select one of the two options provided at the top of the form: to register for state oversight or to choose deemed status with a specific accrediting organization. Make sure to attach the necessary documents if you select deemed status.
3. Enter the name of your laboratory, the Tax ID number, and the complete address including street number, suite/apt, city, state, and zip code. Provide a valid telephone number and fax number.
4. If applicable, input your CLIA provider number and the legal name of the corporation or association that owns the laboratory. Ensure that a fictitious name permit is on file, and provide its locality.
5. Indicate the type of ownership by checking the appropriate box, and if there is more than one testing site, state the number associated with this CLIA number. Use a supplementary sheet if necessary to list partners or corporate officers.
6. List the laboratory director(s) along with their contact details, including their address and hours on site. Include all required names and addresses, using supplementary sheets if more space is needed.
7. Ensure the application is signed by the owner or an authorized representative, along with the laboratory director. Print the names, titles, and dates of signing in the respective fields.
8. Once you have filled out both pages accurately, review for any errors or omissions. Save your changes and then download, print, or share the completed form as required.

Complete your application for the Lab 144 online today and ensure a seamless submission process.