Main Body

CLEP: Limited Service Laboratories

Limited Service Laboratory Registration Application Materials

Limited Service Laboratories include hospital extension clinics, nursing homes, home health care agencies, school/student health services, dialysis facilities, ambulatory surgery centers, county health departments, correctional facilities, ambulance/rescue squads and other direct patient care facilities performing only waived and/or provider-performed microscopy procedures (PPMP).

Facilities must first register with the Clinical Laboratory Evaluation Program by completing a Limited Service Laboratory Registration Application.

Initial Registration Application Instructions	DOH-4081i	PDF	HTM
Initial Registration Application	DOH-4081	PDF
Multi-Site Registration Application Instructions	DOH-4081MSi	PDF	HTM
Multi-Site Registration Application	DOH-4081MS	PDF

Limited Service Laboratory Registration Change Forms

To document changes in laboratory status, or to add or delete tests, use the change forms below.

Notification of Change in Laboratory Director	DOH-4236b	PDF
Notification of Change in Laboratory Owner Information	DOH-4236c	PDF
Notification of Change in Laboratory Location	DOH-4236d	PDF
Notification to Add/Delete Test(s)	DOH-4236e	PDF
Notification of Change in Laboratory Name	DOH-4236f	PDF

Reference Material

Public Health Law Pertaining to Limited Service Laboratories	PDF
Standard Practices in Laboratory Medicine for Limited Service Laboratories	PDF
Blood Lead Screening Standards of Practice (for Waived Testing Devices)	PDF
LeadCare II Device Q&A		HTM
Contact Us		HTM

Mailing Instructions

Mail the form with original signatures to:

Questions should be directed to the Clinical Laboratory Evaluation Program by telephone at (518) 402-4253, or by email: CLEPLTD@wadsworth.org