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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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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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