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LABORATORY FIELD SERVICES  

Submit Changes


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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. 

 

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

  • 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. An initial fee is required for a downgrade or upgrade.  Be sure to 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

email

You may also email a scanned copy of the forms  or any questions to:

LFScc@cdph.ca.gov

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