Directors Attestation {LAB 183}

LAB 183 - DIRECTOR'S ATTESTATION. This form is used by the California Department of Public Health to document a laboratory director's acknowledgment of their responsibilities. It confirms their appointment as director or co-director, holds them accountable for ensuring the laboratory complies with CLIA and California state regulations, and makes them jointly liable with the laboratory owner for violations. The form also requires the director to notify the department of changes in ownership, directorship, name, or location within 30 days and affirms that responsibility continues until a written resignation is received by the department. False statements can result in penalties, including revocation of the laboratory's certification or license. www.FormsWorkflow.com