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LABORATORY FIELD SERVICES

ā€‹signpost How to Submit a Multiple Site License Application

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ā€‹ Summary ā€‹Page # ā€‹Step #
ā€‹A.   Log In ā€‹1 ā€‹1-4
ā€‹B.   Add New Business (Ownership Information) ā€‹1 ā€‹5-14
ā€‹C.   Add New Primary Testing Site (Tests Performed, Laboratory Director) ā€‹1 ā€‹15-29
ā€‹D.   Select sites to include in the application ā€‹2 ā€‹30-32
ā€‹          a. Add Site (Secondary Testing Site #1, #2, #3, etc.) ā€‹2 ā€‹30-32
ā€‹E.   Select Multisite License Qualification ā€‹2 ā€‹33-37
ā€‹F.   Review Business Information ā€‹2 ā€‹38
ā€‹G.  Review Primary Testing Site Information ā€‹2 ā€‹39
ā€‹H.  Review Secondary Sites Information ā€‹3 ā€‹40
ā€‹I.    Upload Documents ā€‹3 ā€‹41-42
ā€‹J.   Payment Information Summary ā€‹3 ā€‹43
ā€‹K.  Sign Attestation ā€‹3 ā€‹44-46
ā€‹L.   Pay and Submit Application ā€‹3 47-53
 

  ā€‹ļƒ« The online application system is optimized for use on your desktop or laptop computer. 


 A. Log In

step 1Log in using your username/userID or email and password.

1-login

ā€‹step 2On the CDPH Licensing Portal, click the Laboratory Facilities icon.

2-facilities icon

ā€‹step 3Review the Privacy Disclaimer. Click the checkbox to agree, then click Proceed.

3-privacy disclaimer

step 4ā€‹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.

4-are you an owner
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 B. Add New Business (Ownership Information)

step 5Since your site is new and doesnā€™t exist in our database, click New or Start New Application.

5-new business

step 6Notice the system assigned application ID ā€“ you can use this as a reference when contacting us specifying the application.

6-add new business button

step 7Add your Business information. Click Next.

ā€‹7-business info ā€‹

In this example, weā€™re selecting County as the Ownership Type.

7-ownership type

step 8The next screen will ask for your Business Mailing Address. Click Validate first. You should be able to see a ā€œAddress Validatedā€ note before the system allows you to move forward.

step 9Then click Next.

ā€‹8-validate address ā€‹9-address validated

step 10The next screen will let you enter the Business Contact Information. Click Next once you have entered the required information.

ā€‹10-contact information

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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.


step 11Your name will appear under the Ownership Information. Click the Edit icon to specify your Role.

11-edit icon
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(11) A: Click Add Role.

ā€‹11-A Add Role
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(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.

ā€‹11-B and C

step 12On the same screen, click Add if you need to add an owner. At least one owner role must be listed.

12-add owner
ā€‹

 

(12) A: Select Parent Company or Individual.

(12) B: Enter the required information.

(12) C: Click Add Role to assign the appropriate role.

ā€‹12-A, B, and C
ā€‹

 

(12) D:Owner was selected as a Role for this example.

ā€‹12-D

 

ā€‹(12) E: Fill in the required fields.

(12) F: Click Save.

ā€‹12-E and F

step 13Now that youā€™ve added the owner(s) and edited your role, you may click Next.

13-add owner

step 14Click the Next button to proceed adding a Testing Site to the Business you have just entered.

14-Next
 C. Add Primary Testing Site (Tests Performed, Laboratory Director)

step 15Enter your Primary or main Testing Site Information. Complete the required fields. On the Physical Location, click the Validate button.

ā€‹15-validate

 

 

 

ā€‹Note:This exemption is mainly for Public Health laboratories. To avoid delays, leave the selection at ā€œNoā€ if you do not qualify. Refer to BPC 1241.


step 16You should see the ā€œAddress validatedā€ notice before you can click the Next button.

16-validated

step 17On the Test Performed page, Certificate of Waiver or PPMP can click Next after selecting the appropriate Highest Testing Complexity.

17-tests

 

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step 18The next page is where you can enter information on Laboratory Personnel. Click Add New Laboratory Director.

ā€‹18-add director

ā€‹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.

18-add existing personnel

step 19Click Add New Individual or search for the license if licensed by LFS.

19-add new individual

step 20Enter required information and click Add Role.

20-add lab director

step 21Select Laboratory Director.

21-add lab director

step 22Enter Weekly Hours on Site, then tick the CLIA Director. Note:There must be one CLIA Director in a Testing Site.

22-add lab director

step 23Scroll down to License Information. Click Add License.

step 24In this example, Physician and Surgeons is selected as the License Type.

step 25Select 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.

step 26Enter the required License Number.

23-26-add lab director

step 27Scroll down to Test Specialty Information. Click on a test specialty to select, then click the Add button.

27-add lab director

step 28After adding a Laboratory Director, if your test complexity is PPMP, or Moderate, or High ā€“ the system will require you to upload a completed LAB 116.pdf form . Click Next when youā€™re done.

28-add lab director

step 29Click Next to continue.

29-Next
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