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LABORATORY FIELD SERVICES

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Mail-in Application Requirements

announce

Apply online and start testing immediately!

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

 

reminder 		​

Stop and Read:

  • If you have already mailed-in an application, do not submit another application online as this will cause delays.
  • If renewing, do not click "Start New Application" to avoid a gap in licensure which may affect your billing.
  • All forms must be completely filled out and dated.

New License Application

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

Type of License:

  • Registration or Waived/PPMP - Certificate of Waiver (COW) -OR- Certificate for Provider Performed Microscopy Procedures (PPMP)

  • License or Non-Waived - Certificate of Compliance -OR- Certificate of Accreditation
​Paper Application Requirements
for New License Application
 Registration
(Waived | PPMP)​		 License
(​Non-Waived)
​LAB 116 (PDF) (not required if Waived  | required if PPMP)
 No   |    Yes
 Yes
​LAB 144 (PDF)
 ​ No
 ​ Yes
​LAB 144A (PDF)
 ​ No Yes
​LAB 1513 (PDF)
 ​ No ​ Yes
​LAB 155 (PDF)
 Yes ​ No
​LAB 167 (PDF)
 ​ No ​ Yes
​LAB 183 (PDF)
 ​ Yes ​ Yes
​CMS 116 (PDF) Quick Start Guide (PDF) ​ Yes ​ Yes
​CMS 209 (PDF)
 No ​ Yes
​LAB 144B (PDF) (Add this form if multisite) ​ Yes (if multisite) ​ Yes (if multisite)
​Fee (see Mail-in Payment below) Yes
 ​ Yes

Additional Requirements:

​Documentation of Laboratory Director's qualifications
 ​ No
 ​ Yes
​Articles of Incorporation (if POL)
 ​ No
 ​ Yes
​Proficiency Testing, Facility Administration, and Quality Systems Requirements (PDF) (upon request) ​ No ​​ Yes (upon request)
​Proof of accreditation or letter of acceptance ​ Yes (if applicable) ​ Yes (if applicable)

For Out-of-State new license application, view the requirements on the Out-of-State webpage.

Renewal Application

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

Renewing by Mail (with changes)

Example of changes: laboratory name, laboratory director, ownership, tax ID,
address, certificate type, or oversight type.

(If reporting changes only and not renewing, go to Submit Changes webpage to view the requirements.)

Requirements ​CLR, CDR
 ​CLP, CDP
 ​CLF, CDF, CLM, CDA, CLA
​LAB 155R (PDF) (or LAB 101 if received)
 ​ Yes ​ Yes ​ No
​LAB 144R (PDF) (or LAB 101 if received)
 ​ No ​ No ​ Yes
​LAB 116 (PDF)
 ​ No ​ Yes ​ Yes
​LAB 144A (PDF)
 ​ No ​ No ​ Yes
​LAB 167 (PDF)
 ​ No ​ No ​ Yes
​LAB 183 (PDF)
 ​ Yes Yes ​ Yes
​LAB 193 (PDF)
 ​ Yes ​ Yes ​ Yes
​CMS 116 (PDF)
 ​ Yes ​ Yes ​ Yes
​Fee (see Mail-in Payment below) ​$113
 ​$170
 ​See Fee Schedule (PDF)
​Delinquency Fee (if application received after the expiration date) $28 ​$42 ​See Fee Schedule (PDF)

Renewing by Mail (no changes)

​LAB 155R (PDF) (or LAB 101 if received)
 ​ Yes ​ Yes ​ No
​LAB 144R (PDF) (or LAB 101 if received)
 No ​ No ​ Yes
​LAB 116 (PDF)
 ​ No ​ No ​ Yes
​LAB 167 (PDF)
 ​ No No ​ Yes
​Fee (see Mail-in Payment below) ​$113 ​$170 ​​See Fee Schedule (PDF)
​Delinquency Fee (for application received after the expiration date) ​$28 ​$42 ​​See Fee Schedule (PDF)

For Out-of-State renewal application, view the requirements on the Out-of-State webpage.

Multiple Sites

All primary and secondary sites under the same license must submit one set of application forms.
Add these additional requirements if renewing, updating, or adding secondary sites:

​Additional requirements for secondary sites

 ​Renewing ​Adding/Updating
​LAB 144B (PDF) Yes
 ​ Yes
​CMS 116 (PDF) (Section V. Multiple Sites)
 No
 ​ Yes
Additional Fee ​​ + $28/site
 ​ ​+ $28/site


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.

Apply Online and Mail-in a Check

You can start your application online and mail the payment to the address below. Enclose your payment with the completed Payment Request Form (PDF) so we can immediately process your payment and move the application forward. Instructions can be found on our Help page: Mail-in Payment.

Send to LFS

​Mail

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