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LABORATORY FIELD SERVICES

Mail-in Application Forms


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Apply online and start testing immediately!

Under the Temporary Allowance, facilities can immediately start performing Waived COVID-19 Antigen tests. Click here for more details. 

 

reminder

Stop and Read:

If you decide to renew online, do not click Start New Application.  A new application will result in a new State ID and a gap in licensure which may affect your billing.

To Renew, refer to Search and Link Site (pdf) user manual on our Help page.

If you have already mailed-in an application, do not submit another application online as this will cause delays.

New Facility Application

If mailing your new facility application, complete and submit the following forms. After review, we may request more information.

REGISTRATION

LAB 155 (PDF)
LAB 183 (PDF)
CMS 116 (PDF)
LAB 116  (PDF) (Add this form if PPMP)
LAB 144B(PDF)(Add this form if Multisite)

LICENSE

LAB 144 (PDF)
LAB 144A (PDF)
LAB 183 (PDF)
CMS 116 (PDF)
CMS 209  (PDF)
LAB 116 (PDF)
LAB 167  (PDF)
LAB 1513 (PDF)
LAB 144B (PDF)(Add this form if Multisite)
Checklist (PDF): Provide requirements under B2.


Renewal Application

If mailing your renewal application, complete and submit the following forms. After review, we may request more information.

REGISTRATION

If you have changes or updates:

LAB 155R (PDF)
LAB 183 (PDF)
LAB 193 (PDF)
CMS 116 (PDF)
LAB 116  (PDF) (Add this form if PPMP)
LAB 144B (PDF)(Add this form if Multisite)

If you have NO changes:

LAB 101 (Annual Renewal Notice) - signed.

LICENSE

If you have changes or updates:

LAB 144R (PDF)
LAB 144A (PDF)
LAB 183 (PDF)
LAB 193 (PDF)
CMS 116 (PDF)
CMS 209  (PDF)
LAB 116 (PDF)
LAB 167  (PDF)
LAB 1513 (PDF)
LAB 144B (PDF)(Add this form if Multisite)

If you have NO changes:

LAB 116 (PDF)
LAB 167  (PDF)
LAB 183 (PDF)
LAB 101 (Annual Renewal Notice) - signed.

Mail-in Payment

Refer to the Fee Schedule (PDF) and mail a check or money order with the following information:

  • Write your State ID or Application ID (APL / RNL / AMS) on the check.
  • Make the check or money order payable to: California Department of Public Health.
  • Keep a scanned copy of your check / money order.
  • If you started your application online and saved it, please use our Payment Request Form (pdf)to request LFS to process the payment.

Send to LFS

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​Mail to:
California Department of Public Health
Laboratory Field Services
850 Marina Bay Parkway
Bldg. P, 1st Floor
Richmond, CA  94804-6403

emailit

​Email to:
LFScc@cdph.ca.gov

  • Subject line: Include any reference such as State ID, CLIA ID, application ID, and facility name.
  • Body of email: Include information such as type of application (initial, renewal, changes, etc.)
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​Upload Online:                     
Upload the completed and signed forms in your application.

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