Lab144r 2007 form-2025

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39 votes

The document is an application form for obtaining a clinical laboratory license from the California Department of Public Health. It outlines the necessary information and requirements needed to complete the application, including details about the laboratory's ownership, location, directors, and any relevant certifications. The form must be filled out and submitted with a fee to the specified address.

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Click ‘Get Form’ to open the lab144r 2007 form in the editor.
Begin by entering the name of the laboratory exactly as desired on the license in the designated field.
Input your CLIA certificate number and provide the complete laboratory location, including street address, city, state, and ZIP code.
Indicate any changes in laboratory ownership or directorship by filling in the respective dates and details.
Select the type of ownership from the options provided (Individual, Partnership, Corporation, etc.) and fill in all required names and addresses.
Complete sections regarding directors of the laboratory and confirm if your facility is part of a licensed acute care hospital.
Finally, ensure that all signatures are obtained from both the director and owner before submitting your application along with any required fees.

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Versions	Form popularity	Fillable & printable
2018	4.9 Satisfied (27 Votes)
2016	4.3 Satisfied (67 Votes)
2007	4 Satisfied (39 Votes)

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