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Lab 101 form 2025

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4.8 out of 5

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The document outlines the renewal process for clinical laboratory personnel licenses and certificates in California, detailing the continuing education requirements necessary for active license holders. It specifies the number of continuing education hours required for different roles, the submission process for renewal applications, and guidelines for maintaining documentation. Additionally, it provides contact information for inquiries and emphasizes the importance of timely notification of any changes in personal information.

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Click ‘Get Form’ to open the lab 101 form in the editor.
Begin by entering your personal information in the designated fields, including your name, daytime and home telephone numbers, and email address if available.
Indicate whether there has been a change of name or address since your last renewal by selecting 'Yes' or 'No'.
Complete the section regarding any felony or misdemeanor convictions. If applicable, provide an explanation on a supplementary sheet.
In Section 1, list all required information from your continuing education certificates, including the date of issue, California AA number, program title, accrediting agency name, course number, and CE units earned.
For Section 2, document any relevant college or university courses completed since your last renewal. Include the course number and title along with semester/quarter units and course dates.
Finally, sign and date the form to certify that all information is accurate before submitting it as instructed.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (84 Votes)

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