Home
Programs
Office of the State Public Health Laboratory Director
Laboratory Field Services
Submit Lab Changes

LABORATORY FIELD SERVICES

Back

Submit Changes

Apply online and start testing immediately!

Under the Temporary Allowance, facilities can immediately start performing Waived SARS-CoV-2 Point of Care (POC) tests.

You must submit a request for change by mail if you are not renewing. See requirements below.

Laboratory Director Change

There are no additional fees for Laboratory Director changes effective on or after April 1, 2020.

Form Requirements:

LAB 193 (PDF)- Notification of Laboratory Change
LAB 183 (PDF)- Director Attestation
CMS 116 (PDF)- to update CLIA certificate

We will contact you by email if additional information is required upon review. Be sure to include a valid email address on each form to avoid delay. See "Send Application To" below.

Ownership Change

There are no additional fees for ownership changes effective on or after April 1, 2020.

Form Requirements:

LAB 193 (PDF) - Notification of Laboratory Change
LAB 183 (PDF) - Director Attestation
CMS 116 (PDF) - to update CLIA certificate
LAB 1513 (PDF) - Disclosure of Ownership (required for moderate/high complexity labs)

We will contact you by email if additional information is required upon review. Be sure to include a valid email address on each form to avoid delay. See "Send Application To" below.

Other Changes

Basic Changes

Basic changes such as address, phone, fax, contact person, email, laboratory name (without ownership change), certificate corrections, and laboratory closure, require these forms:

LAB 193 (PDF) - Notification of Laboratory Change
CMS 116 (PDF) - to update CLIA certificate

Upgrading or Downgrading

If you are upgrading or downgrading outside your renewal time, submit an initial application and apply the appropriate initial fee. Refer to New Facility Application requirements in the Mail-in Applications Forms webpage to find the appropriate set of forms.

We will contact you by email if additional information is required upon review. Be sure to include a valid email address on each form to avoid delay. See "Send Application To" below.