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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 registration is issued remain after the change (see BPC 1211 (j)). The laboratory must submit a completed application for a new clinical laboratory registration 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.

The forms listed below can be accessed on the Laboratory Field Services (LFS) forms page.

 

Required Federal Form:

For major changes in your site since the last renewal, please complete and mail the required federal form, CMS 116 to the address below.

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

Required Fee:

Submit registration 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 registration fees please refer to the Laboratory Field Services (LFS) fee schedule (PDF).

 

Mail to:

CDPH – Laboratory Field Services
Laboratory Facility Registration
850 Marina Bay Parkway, Bldg. P, 1st Floor
Richmond, CA 94804-6403

  

​Minor Change of Directorship

Required Documents & State Forms:

Required Federal Form:

For minor changes in your site since the last renewal, please complete and mail the required federal form, CMS 116 to the address below.

Mail to:

CDPH – Laboratory Field Services
Laboratory Facility Registration
850 Marina Bay Parkway, Bldg. P, 1st Floor
Richmond, CA 94804-6403

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