Doh 4081 ms-2026

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The document outlines the application process for not-for-profit and government Limited Service Laboratories in New York State to register additional permanent testing locations under a multi-site network. It provides detailed instructions on eligibility, required information for primary and additional testing sites, types of tests that can be performed, and certification requirements. The goal is to streamline the registration process for laboratories performing waived and provider-performed microscopy procedures under a single CLIA registration number.

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Click ‘Get Form’ to open the doh 4081 ms in the editor.
Begin with Section 1, where you will enter the Primary Laboratory Information. Fill in the legal name, address, and contact details of your primary laboratory.
Proceed to Section 2 to provide information about the new permanent testing site. Include the site name, county, address, and contact information.
In Section 3A, list all Waived test procedures you wish to perform at the new site and estimate the annual test volume for each procedure.
Continue to Section 3B to indicate any Provider-performed Microscopy (PPM) Procedures you plan to conduct and provide their estimated annual volumes.
Finally, complete Section 4 by having the Laboratory Director sign and date the application. Ensure all signatures are original as stamps are not accepted.

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Versions	Form popularity	Fillable & printable
2022	4.5 Satisfied (56 Votes)
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