
Get the inapp 813.doc. Description. NEW YORK STATE DEPARTMENT OF HEALTH Wadsworth Center Clinical Laboratory Evaluation Program Empire State .
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How to fill out the NY DOH-3494 online
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.
- Click ‘Get Form’ button to obtain the NY DOH-3494 form and open it in the editor.
- Begin filling out the 'Contact Person' section. Specify the title of the contact person and provide their telephone number and email address.
- In the 'General Laboratory Information' section, enter the name of the laboratory, the address, and select the testing hours.
- Indicate if the laboratory is a small business by checking the appropriate box.
- Fill out the 'Ownership Information' section, including the type of ownership and the name and address of the owner or corporation.
- Select the facility type from the options provided, choosing the one that best describes your laboratory.
- Complete the 'Other Approvals' section by providing any applicable CLIA or NYS Medicaid numbers.
- In the 'Laboratory Testing' section, describe the laboratory facility and ensure to include a list of your test offerings to New York State clients.
- Provide details about the laboratory directorship, including the degrees held and hours of availability.
- List all assistant directors along with their qualifications and hours, ensuring to sign and date the attestation on the appropriate page.
- Indicate the categories or subcategories for which you are seeking a laboratory permit. Make sure to attach any additional sheets if necessary.
- Finally, review the certification section, ensure all information is accurate, and complete it with the necessary signatures.
- 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.
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