Our editors have reviewed the official CDPH phlebotomy license instructions to prepare this step-by-step guide. Using FormsPal's online editor, you can complete and download the LAB 101 form in minutes.
Step 1: Click the orange "Get Form Now" button at the top of this page to open the form in the online editor.
Step 2: Enter your personal details and license information. You will see fields for your name, license number, telephone number (day and home), and mailing address.
Complete the required fields in Section 1: your name, license number, mailing address, and telephone contact details. Check the applicable box and provide your signature at the bottom of the form as directed.
Step 3: Complete the College or University section (Section 2) if applicable. Enter the institution name, course title, semester or quarter units, and course completion date. Answer the required question about any felony convictions within the past seven years.
Step 4: When you have completed all sections, click "Done" to save. You can download the finished form, print a copy, or email it directly from the editor.
Step 5: Keep a copy of the completed form and all supporting continuing education certificates for at least four years. The CDPH may request this documentation during a random audit of your license records.
Looking for related California health department forms? See also: CDPH 278B form, CDPH 283-A form, or the clinical laboratory license to operate.
