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Laboratory Field Services

Registration Renewal Instructions for California Clinical Laboratories

The registration renewal instructions found on this page apply to clinical laboratories and facilities performing waived and provider-performed microscopy procedures (PPMP) clinical laboratory testing with state LAB IDs beginning with CLR, CLP, CDR, CDP.

Required Forms: 

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

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

LAB 155R (PDF)  Renewal Application for Clinical Laboratory Registration

LAB 183 (PDF) Director Attestation (each director or co-director must file a separate attestation)

LAB 116 (PDF)  Laboratory Personnel Report Form (required for PPMP registration renewal).
This form should list all persons directing, supervising, performing testing, and releasing results of non-waived testing performed on specimens from California. If you submit a database printout, please fill out the top of the form and state that a list of personnel is attached.

Other Requirements:

For changes in your site since the last renewal, please complete and mail the required federal form, CMS 116 to the address below. This form is not necessary if there are no changes in your site since the last renewal.

  • 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 the non-refundable renewal application fee in the form of a check or money order. Credit card payments are not accepted. The amount of the fee is indicated on your annual renewal notice. Please write your state LAB ID (e.g.. XXX 123456) on your check or money order so that we can apply the payment to your file. Make the check or money order payable to: California Department of Public Health. 

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

Mail to:

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

For additional information or assistance you may email LFScc@cdph.ca.gov.

 

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