Application for Renewal Clinical Lab License for Labs out of California. LAB 144 ROS 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by selecting your registration option: either state oversight or deemed status with an accrediting organization. If you choose deemed status, ensure to attach the required accreditation documentation.
3. Fill in the laboratory's name, Tax ID number, address, city, county, state, zip code, telephone number, fax number, and email address accurately.
4. Provide your CLIA provider number and indicate the legal name of the corporation or association owning the laboratory. Specify the type of ownership and list all relevant names and addresses as needed.
5. List all laboratory directors along with their addresses and hours on site. Ensure that this information is complete and accurate.
6. Attach necessary documents such as certification letters from CMS, test methodologies, survey reports, proficiency testing results, and completed personnel forms as specified in the application.
7. Finally, sign the application where indicated by both the laboratory director and owner before submitting it to the California Department of Public Health.

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