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Submit Lab Changes

LABORATORY FIELD SERVICES

Submit Changes

You must submit a request for change by email if you are not renewing. See requirements below.

Laboratory Director Change

There are no additional fees for Laboratory Director changes effective on or after April 1, 2020.

Form Requirements:

LAB 193 (PDF)- Notification of Laboratory Change
LAB 183 (PDF)- Director Attestation
CMS 116 (PDF)- to update CLIA certificate

We will contact you by email if additional information is required upon review. Be sure to include a valid email address on each form to avoid delay. See “Send Application To” below.

Ownership Change

There are no additional fees for ownership changes effective on or after April 1, 2020.

Form Requirements:

LAB 193 (PDF) - Notification of Laboratory Change
LAB 182 (PDF) - Owner's Attestation
CMS 116 (PDF) - to update CLIA certificate
LAB 1513 (PDF) - Disclosure of Ownership (required for moderate/high complexity labs)

We will contact you by email if additional information is required upon review. Be sure to include a valid email address on each form to avoid delay. See “Send Application To” below.

Other Changes

Basic Changes

Basic changes such as address, phone, fax, contact person, email, laboratory name (without ownership change), certificate corrections, and laboratory closure, require these forms:

LAB 193 (PDF) - Notification of Laboratory Change
CMS 116 (PDF) - to update CLIA certificate

Upgrading or Downgrading

Email us: LFScc@cdph.ca.gov

Adding a New Secondary Site

If you are adding a new secondary site outside your renewal cycle, follow the instructions on this user manual for Adding a New Secondary Site. Keep in mind that this application cannot be submitted if there is an existing application for the primary site. Contact us for an update on the existing application.

We will contact you by email if additional information is required upon review. Be sure to include a valid email address on each form to avoid delay.