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Laboratory Field Services

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Laboratory Director Change

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

Form Requirements:

We will contact you by email if additional information is required upon review. It is important that you 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 that are effective on or after April 1, 2020.

Form Requirements:

  • Skip to main contentLAB 193 - Notification of Laboratory Change
  • Skip to main contentLAB 183 - Director Attestation
  • Skip to main contentCMS 116 - to update CLIA certificate
  • Skip to main contentLAB 1513 - Disclosure of Ownership and Control Interest Statement (required for moderate/high complexity labs)

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


Additional Secondary Sites

Form Requirements:

  • Skip to main contentLAB 144B - Application for Additional Testing Site
  • Skip to main contentLAB 155R - Application for Renewal Registration (for CLR, CDR, CLP, CDP, CNC, CEW, CEP)
  • Skip to main contentLAB 144R - Application for Renewal License (for CLF, CDF, CLA, CDA, CLM, CEA, CEC)
  • Skip to main contentLAB 183 - Director Attestation
  • Skip to main contentCMS 116 - to update CLIA certificate
  • Fee required: $28 per new secondary site.Skip to main contentSee Fee Schedule
  • No Fee required for these State ID types: CEW, CEP, CEA, CEC

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


Other Changes

Basic changes such as address, phone, fax, email, laboratory name (without ownership change), certificate corrections, and closure of business, upgrade or downgrade (initial fee required), require these forms:

  • Skip to main contentLAB 193 - Notification of Laboratory Change
  • Skip to main contentLAB 183 - Director Attestation
  • Skip to main contentCMS 116 - to update CLIA certificate

We will then contact you by email if additional information is required upon review. An initial fee is required for a downgrade or upgrade.  It is important that you include a valid email address on each form to avoid delay. See "Send Application To" below.


Exempt Sites (CNC)

All facilities with State ID that starts with CNC (e.g.: CNC-333333) require review of exempt status. To know if you are truly exempt, please read this carefully.

For any change, submit these forms:

  • Skip to main contentLAB 155 - Application for Initial Registration
  • Skip to main contentLAB 193 - Notification of Laboratory Change
  • Skip to main contentLAB 183 - Director Attestation
  • Skip to main contentCMS 116 - to update CLIA certificate

We will contact you by email if additional information is required upon review.  AnSkip to main contentinitial fee may be required if exempt status no longer applies. It is important that you include a valid email address on each form to avoid delay. See "Send Application To" below.


Send Application To...


mail

Scan and save a copy of the signed and completed forms before mailing to this address:

California Department of Public Health
Laboratory Field Services
850 Marina Bay Pkwy, Bldg. P-1st Floor
Richmond, CA 94804-6403

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You may also email a scanned copy of the forms  or your other inquiries to:

LFScc@cdph.ca.gov

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