Application For Clinical Laboratory License
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Application For Clinical Laboratory License Form. This is a California form and can be use in Department Of Health And Human Services Statewide.
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Tags: Application For Clinical Laboratory License, LAB 144, California Statewide, Department Of Health And Human Services
Agency APPLICATION F OR CLINICAL L ABORATORY Instructions: Agency 7. Laboratory Directors (M.D., D.O.This s tatement must be s igned b y th e o wner o r a p erson l egally a uthorized t o b ind th e o wner a nd th e laboratory d irector. I d eclare th at the fo regoing s tatements are tr ue a nd c orrect to th e b est of my knowledge a nd b elief. Hour Per Week On Site Name Address number, street) City State Zip Code Name Address number, street) City State Zip Code Name Address number, street) City State Zip Code Name Address number, street) City State Zip Code Name Address number, street) City State Zip Code Name Address number, street) City State Zip Code Type or Print Name Laboratory Director Signature Title Date Ow ner Signature Type or Print Name Title Date
