Lab 183 form 2026

See details

4.8 out of 5

156 votes

The document is a Director's Attestation from the California Department of Public Health, where the laboratory director or co-director affirms their responsibilities for the clinical laboratory's compliance with CLIA and state regulations. It outlines the legal obligations, potential liabilities, and consequences of non-compliance, including revocation of certification and penalties for false statements. The director must notify the Department of any changes in ownership or directorship and remains responsible until formally resigning.

Here's how it works

01. Edit your lab 183 online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send lab 183 form via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out lab 183 form with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the lab 183 form in the editor.
Begin by entering the effective date at the top of the form. This is crucial as it indicates when you assume directorship responsibilities.
Fill in the name and address of your clinical laboratory. Ensure accuracy, as this information is vital for identification purposes.
Input your CLIA number and State ID number if known. These identifiers are essential for compliance with state regulations.
Review the attestation statement carefully. As a director, you must acknowledge your responsibilities regarding testing accuracy and compliance with laws.
Sign and date the document at the bottom. This signature confirms your understanding and acceptance of the responsibilities outlined.
Finally, provide your printed name, title, address, and contact number in the designated fields to complete your submission.

Start using our platform today to fill out your lab 183 form easily and for free!

See more lab 183 form versions

We've got more versions of the lab 183 form form. Select the right lab 183 form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2007	4.8 Satisfied (156 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

lab183

LAB 182 Form Lab 116 form Lab 144a Form LAB 193 form Cdph lab 183 form Laboratory Field Services login Lab 1513 form LAB 116 cdph

Security and compliance

At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.

Learn more

Lab 183 form 2026

Here's how it works

How to use or fill out lab 183 form with our platform

See more lab 183 form versions

Complete this form in 5 minutes or less

lab183

Security and compliance

Related forms

Complete this form in 5 minutes or less

attestation form

Try more PDF tools