Health ny professionalsemsNEW YORK STATE DEPARTMENT OF HEALTH LIMITED TESTING 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin with Section 1 - Primary Laboratory Information. Fill in the legal name and address of your Primary Limited Service Laboratory, along with the CLIA & PFI numbers if available.
  3. Proceed to Section 2 - Additional Testing Site Information. Enter details for the new permanent testing location, including its name, county, address, and contact information.
  4. In Section 3A, list all Waived test procedures you wish to perform at the new site. Provide estimated annual test volumes for each procedure.
  5. Complete Section 3B by indicating any Provider-performed Microscopy (PPM) Procedures you plan to conduct and their estimated annual volumes.
  6. Finally, ensure that Section 4 is signed by the Laboratory Director responsible for the testing. Remember that original signatures are required.

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New York State Public Health Law (Article 5, Title V, Section 574) and regulations (Subsection 58-1.10 (g) of 10NYCRR) require that all specimens obtained within New York State be tested by a laboratory that holds a New York State clinical laboratory permit, including test-specific approval when required.
Phone. 1-800-663-6114 - Complaints/Inquiries (Monday-Friday 9:00 a.m - 5:00 p.m.)
The New York State Department of Health (State DOH) protects, improves, and promotes the health, productivity, public safety, and wellbeing of all New Yorkers.
General Requirements submit the application and fee for initial certification; be of good moral character; be at least 18 years of age; meet education or alternative to education requirements; and. meet examination requirements.
The Centers for Medicare Medicaid Services (CMS) regulates all laboratory testing (except research) performed on humans in the U.S. through the Clinical Laboratory Improvement Amendments (CLIA) program. The objective of CLIA is to ensure quality laboratory testing.