Doh 408 1ms 2025

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The document is an application form for initial limited service laboratory registration with the New York State Department of Health. It outlines the necessary information and requirements for laboratories seeking registration, including application fees, laboratory type, ownership details, management information, and specific tests to be performed. The form emphasizes the importance of providing complete and accurate information to avoid delays in processing.

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Click ‘Get Form’ to open the doh 408 1ms in the editor.
Begin by filling out the CLIA Status and Application Type section. If your laboratory has a CLIA number, enter it. Select the type of registration you are applying for: Single-Site or Multi-Site.
In the General Information section, provide details about your laboratory, including its name, address, and contact information. Ensure all fields are completed accurately.
Complete the Laboratory Type section by selecting the option that best describes your facility from the provided list.
Fill in Ownership Information with details about the owner or corporation operating the laboratory. Indicate if it is a small business.
Provide Affiliation and Management details if applicable, including names and addresses of affiliated laboratories or management companies.
Complete the Laboratory Directorship section with information about your laboratory director, including their qualifications and employment status.
Indicate any Waived Test Procedures and Provider-Performed Microscopy Procedures you intend to perform by checking off relevant boxes and providing estimated annual test volumes.
Finally, review all sections for accuracy before signing and dating where indicated at the end of the form.

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