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- Click ‘Get Form’ to open the lab144r 2016 form in the editor.
- Begin by selecting your registration option. Choose either 'state oversight' or 'deemed status' and provide the necessary accreditation details if applicable.
- Fill in the laboratory's name, tax ID number, address, city, county, state, zip code, telephone number, fax number, and email address in the designated fields.
- Enter your CLIA provider number and specify the legal name of the corporation or association owning the laboratory. Ensure you include any fictitious name permits as required.
- Indicate the type of ownership by checking the appropriate box and providing names and addresses for all relevant parties involved in ownership.
- List all laboratory directors along with their contact information and hours on site. Make sure to include all necessary signatures at the end of the form.
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