​ How to Submit a Multiple Site License Application

  ​ The online application system is optimized for use on your desktop or laptop computer. 

Log in using your username/userID or email and password.

​On the CDPH Licensing Portal, click the Laboratory Facilities icon.

​Review the Privacy Disclaimer. Click the checkbox to agree, then click Proceed.

​Choose Yes if you are the owner of the facility you are creating an account for. Choose No if you are NOT the owner. Click Submit.

Yes, I’m an Owner Select Yes, then Submit. Verify your key demographics. Make sure all required fields marked with asterisks (*) are complete. Then, click Submit. No, I’m not an Owner Select No, then Submit. Verify your key demographics. Add your Professional Designation/s if desired. Then, click Submit. ​

Since your site is new and doesn’t exist in our database, click New or Start New Application.

Notice the system assigned application ID – you can use this as a reference when contacting us specifying the application.

Add your Business information. Click Next.

​	​ In this example, we’re selecting County as the Ownership Type.

The next screen will ask for your Business Mailing Address. Click Validate first. You should be able to see a “Address Validated” note before the system allows you to move forward.

Then click Next.

​

​

The next screen will let you enter the Business Contact Information. Click Next once you have entered the required information.

​	​ Note:Please make sure that your email address is correct. Our system will send notices and the certificate to this email address, and to the Testing Site email address.

Your name will appear under the Ownership Information. Click the Edit icon to specify your Role.

​                      (11) A: Click Add Role.	​
​ (11) B: In this example, Authorized Representative was selected. Note: Authorized Representative Role will NOT be displayed on the certificate as Owner. Owner Roles that will be displayed on the certificate: Board of Directors Chief Executive Officer Owner Shareholder Vice President Other (11) C: Click Save.	​

On the same screen, click Add if you need to add an owner. At least one owner role must be listed.

​   (12) A: Select Parent Company or Individual. (12) B: Enter the required information. (12) C: Click Add Role to assign the appropriate role.	​
​   (12) D:Owner was selected as a Role for this example.	​
​(12) E: Fill in the required fields. (12) F: Click Save.	​

Now that you’ve added the owner(s) and edited your role, you may click Next.

Click the Next button to proceed adding a Testing Site to the Business you have just entered.

Enter your Primary or main Testing Site Information. Complete the required fields. On the Physical Location, click the Validate button.

​	​Note:This exemption is mainly for Public Health laboratories. To avoid delays, leave the selection at “No” if you do not qualify. Refer to BPC 1241.

You should see the “Address validated” notice before you can click the Next button.

On the Test Performed page, Certificate of Waiver or PPMP can click Next after selecting the appropriate Highest Testing Complexity.

For Certificate of Compliance or Accreditation, click to view the instructions (A-D): A. Select Highest Testing Complexity: High or Moderate. Select the applicable Federal Certificate Type if necessary. ​ ​ B. Select Annual Test Volume of California Specimens. C. Select The Federal Database to add tests -OR- upload a completed LAB 144A (PDF). A window will pop-up. Use any field to enter your test information. In this example, we are typing “moderate” in the Test Complexity field to view and select the appropriate Analyte. Click Save to add the selected items to your application.   D. You can also select Test not in the Federal Database option to add tests that are not found in The Federal Database. Click the Add Test button. Type the information and click Save when you’re done. ​

The next page is where you can enter information on Laboratory Personnel. Click Add New Laboratory Director.

​	​Note:You may click Add From Existing Personnel button when it shows. This button will appear as you add your secondary sites. This will allow you to select previously added Laboratory Directors.

Click Add New Individual or search for the license if licensed by LFS.

Enter required information and click Add Role.

Select Laboratory Director.

Enter Weekly Hours on Site, then tick the CLIA Director. Note:There must be one CLIA Director in a Testing Site.

Scroll down to License Information. Click Add License.

In this example, Physician and Surgeons is selected as the License Type.

Select Yes if license is issued in California. If No is selected, the system will require you to enter Education, Training, and Experience details below the screen.

Enter the required License Number.

Scroll down to Test Specialty Information. Click on a test specialty to select, then click the Add button.

After adding a Laboratory Director, if your test complexity is PPMP, or Moderate, or High – the system will require you to upload a completed LAB 116.pdf form . Click Next when you’re done.

Click Next to continue.