Get Ny Doh-3494 2016

The NY DOH-3494 form is essential for laboratories in New York seeking an initial permit. This guide provides clear, step-by-step instructions for filling out the form online, ensuring that users can navigate the process smoothly and efficiently.

Follow the steps to complete your NY DOH-3494 application online.

1. Click ‘Get Form’ button to obtain the NY DOH-3494 form and open it in the editor.
2. Begin filling out the 'Contact Person' section. Specify the title of the contact person and provide their telephone number and email address.
3. In the 'General Laboratory Information' section, enter the name of the laboratory, the address, and select the testing hours.
4. Indicate if the laboratory is a small business by checking the appropriate box.
5. Fill out the 'Ownership Information' section, including the type of ownership and the name and address of the owner or corporation.
6. Select the facility type from the options provided, choosing the one that best describes your laboratory.
7. Complete the 'Other Approvals' section by providing any applicable CLIA or NYS Medicaid numbers.
8. In the 'Laboratory Testing' section, describe the laboratory facility and ensure to include a list of your test offerings to New York State clients.
9. Provide details about the laboratory directorship, including the degrees held and hours of availability.
10. List all assistant directors along with their qualifications and hours, ensuring to sign and date the attestation on the appropriate page.
11. Indicate the categories or subcategories for which you are seeking a laboratory permit. Make sure to attach any additional sheets if necessary.
12. Finally, review the certification section, ensure all information is accurate, and complete it with the necessary signatures.
13. Once all sections are complete, you can save changes, download, print, or share the form as needed.

Complete your NY DOH-3494 application online today and ensure your laboratory is properly licensed.