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laboratory field services

​Major & Minor Changes of Directorship

Definition:

A major change in laboratory directorship” means a change in laboratory director or directors resulting in a situation where less than 50 percent of the laboratory directors to whom the current laboratory license is issued remain after the change (see BPC 1211 (j)). The laboratory must submit a completed application for a new clinical laboratory license within 30 days of a major change of directorship or cease engaging in clinical laboratory practice.
 

Major Change of Directorship

Required State Forms:

Original signatures and dates must be on all forms. Copies are not acceptable.

State forms can be accessed on the Laboratory Field Services (LFS) forms page.

Required Federal Forms:

For major changes in your site since the last renewal, please complete and mail the required federal forms  to the address below.

Required Fee:

Submit license fee payable in the form of a check or money order to the State of California Department of Public Health. Credit card payments are not accepted. The fee is non-refundable and subject to change with each fiscal year.

For a full list of clinical laboratory license fees please refer to the Laboratory Field Services (LFS) fee schedule (PDF).

 

Mail the required state and federal forms, documents and fee to:

California Department of Public Health
Laboratory Field Services
850 Marina Bay Parkway, Bldg. P, 1st Floor
Richmond, CA 94804-6403

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​Minor Change of Directorship

Required Documents:

  • Letter of Resignation (if applicable) including effective date and original signature of the departing director.

  • Letter of Addition (if applicable) including effective date and the original signature of the incoming director.

  • LAB 183 (PDF)Director Attestation of each new director or co-director with original signature

  • LAB 193 (PDF) — Notification of Laboratory Change

  • CMS 116 (PDF)- CLIA application form for new or for changes in your site such as change in laboratory director, ownership, change in certificate type, address, etc.

Mail the required state and federal forms, documents  to:

California Department of Public Health
Laboratory Field Services
850 Marina Bay Parkway, Bldg. P, 1st Floor
Richmond, CA 94804-6403

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