The California LAB 183 Director’s Attestation is a one-page form the California Department of Public Health (CDPH) requires from every clinical laboratory director before it will issue or renew a laboratory license or registration. It is not the application. It is a signed acknowledgment that you, as director, personally accept legal responsibility for the lab’s compliance with state law and the federal Clinical Laboratory Improvement Amendments (CLIA). You download the PDF from CDPH’s controlled-forms library and upload it with the rest of your application through the state licensing portal.
The form is short, but what you are agreeing to is not. Read it before you sign, because the obligations it creates reach your personal license, your future employment in the field, and the lab’s ability to keep operating.
What You Are Agreeing to When You Sign
LAB 183 lists each obligation as a numbered statement. The director’s signature at the bottom confirms all of them. The most consequential comes from Business and Professions Code Section 1265(b): the director is jointly and severally responsible with the lab’s owners for any violation of law the facility commits. Regulators can pursue you personally, not only the business entity.
The other acknowledgments on the form:
- You are responsible for the accuracy and reliability of every test the laboratory performs.
- You and the owners must notify CDPH in writing within 30 days of any change in ownership, directorship, laboratory name, or location. Failure to report triggers automatic revocation of the state license or registration.
- A false statement or misrepresentation of a material fact on the application is grounds for revoking the lab’s CLIA certificate and its state license or registration.
- If the lab’s certificate or license is revoked for deficient or unlawful practices that occurred under your directorship, you are barred from owning, operating, or directing any clinical laboratory for at least two years.
- You remain legally responsible for the laboratory until the day CDPH receives a signed statement of your resignation or termination.
Two of these deserve a second look before you sign. The two-year bar can end a career in laboratory management. And the “until CDPH receives written notice” rule means walking away from a job is not the same as ending your legal exposure; if the paperwork never reaches the department, the responsibility stays with you.
How to Fill Out and Sign the Form
Download LAB 183 from the CDPH controlled-forms library. The fields are straightforward: laboratory name, director’s full legal name, professional license number, and date, followed by the signature.
A few points that cause delays:
- Enter the laboratory name exactly as it appears on the rest of the application. A mismatch in punctuation or wording slows review.
- Use your full legal name as it appears on your professional licensing board records. Nicknames or abbreviated forms create verification problems.
- Fill in the professional license number. A blank there is one of the more common reasons applications come back.
- If the lab has co-directors, each one must complete and sign a separate LAB 183. One form covering two directors will not be accepted.
Keep a copy. You may need to produce it years later, particularly if you leave the position and need to prove when your responsibility ended.
Where LAB 183 Fits in the Application
LAB 183 travels with a larger application package. Under BPC Section 1265(b), that package has to include the full legal name of every owner and director, the facility name and physical address, a complete list of every test performed with annual volumes, the test kits and methodologies used, the qualifications of everyone who directs, supervises, or performs testing, and, for labs with a provider-performed microscopy certificate, the name of each PPM provider. Both the owners and the directors sign the application itself before the lab opens.
Whether you need a license or a registration determines which track your application follows. A license is required for any facility performing moderate- or high-complexity testing under CLIA, and the director has to meet the qualifications in BPC Section 1209 for that complexity level. A registration applies to facilities performing only waived tests, PPM procedures, or both; the eligible director pool is broader but comes with scope limits tied to each professional category. Choosing the wrong one can lead to denial.
Submission is online only. Paper applications are no longer accepted. You apply through the CDPH licensing portal at mylicense.cdph.ca.gov, after creating an account at accountportal.cdph.ca.gov if you do not already have one. CDPH recommends a desktop or laptop with a current browser; the portal does not work reliably on tablets or phones.
One warning the portal displays, and that CDPH takes seriously: if you are renewing an existing license, do not click “Start New Application.” That creates a new state ID and a gap in your licensure history, which can disrupt billing with insurers and Medicare.
Fees are paid as part of the application and vary by registration type and, for licenses, annual test volume. A late renewal carries a delinquency surcharge of 25 percent of the base fee.
For questions, or to confirm a submission was received, contact the Laboratory Licensing Section at 850 Marina Bay Parkway, Building P, 1st Floor, Richmond, CA 94804. CDPH’s posted processing estimates are roughly two months for initial applications, about six weeks for online renewals, and about two months for changes in ownership, location, or director. There is no expedited option, and an incomplete submission moves you to the back of the queue. If staff cannot reach you or you fail to respond to a request for information, the department may abandon the application after 30 days.
After You Sign: Obligations That Follow You
The attestation is not a one-time filing. The obligations you acknowledged by signing it continue for as long as you are the director of record, and some reach beyond that.
The 30-day change-notification rule is the one that catches the most labs. Any change in ownership, directorship, laboratory name, or location has to be reported to CDPH in writing within 30 days. The statute gives the department no discretion. Selling a partial interest, bringing on a co-director, or moving across the street all start the clock. A missed notice means automatic revocation.
Resignation works the same way in reverse. Your responsibility as director does not end when you stop coming to work, when your employment contract ends, or when a replacement is hired. It ends when CDPH receives your signed resignation or termination notice. Send it in writing, keep proof of delivery, and do not assume the lab will handle it for you.
False statements on any application or renewal are grounds for revoking both the state license or registration and the federal CLIA certificate. If revocation is based on deficient practices that occurred during your directorship, the two-year bar on owning, operating, or directing any clinical laboratory applies to you personally. CMS can separately revoke Medicare billing privileges, with a re-enrollment bar of one to three years.
Licensed labs are inspected by CDPH at least once every two years, and both licensed and registered labs are subject to federal inspection by CMS or its agents at any time. Registered labs are not routinely inspected by the state but can be investigated on a complaint.
None of this is hidden. It is all on the form you sign. The point of LAB 183 is to make sure you cannot later say you did not know.