Medical Laboratory Board
When completing the application process below, you will be required to submit an official transcript from the institution where you completed your education. The transcript must be mailed directly from the educational institution to the board office located at 665 Mainstream Drive, Nashville, TN 37243.
Applications
► Applying for initial licensure from your professional licensing board has become a bit easier. For the past year, the Department of Health has been working on an online application process that will allow all health care professionals to apply online for an initial license and complete (and update as necessary) a practitioner profile mandatory for certain professions. The process is user friendly and convenient and even allows you to pay for your initial application utilizing a credit card, debit card or e-check. You will also be able to upload many of the documents required to complete your initial application! Please go to the initial application link below to begin the online process.
- Application for a License to Operate a Medical Laboratory (Paper Application - PH 1020)
- Application for a License to Operate a Collection Station (Paper Application - PH 3706)
- Guidelines for Online Application
- Medical Laboratory Personnel Online Application ( Paper Application PH-1056)
- Mandatory Practitioner Profile Questionnaire for Licensed Health Care Providers (Paper Form PH-3585)
- Declaration of Citizenship (PH-4183)
- Clearance from Other State Licensure Boards Attachment 1
- Training Program Verification Attachment 2
- International Transcript Evaluation Agencies
- Personnel Roster form
- Facility Lab Fee for Change in Director, Location or Owner (PH-3947) 0911
- Waived Testing Notification Form (PH-3653) - revised 2021
- Screening Program Notification (PH-3654)
- Application for License to Operate Medical Laboratory Training Program for Medical Laboratory Personnel (PH-2002)
- Clinical Facility Fact Sheet for Training Rotation Sites
- Reinstatement Application (Paper Form PH-3571)
- Name and Address Change Request (PH-3619)
- Affidavit of Retirement From Practice in Tennessee (PH-3460)
- Expedited Licensure for Military Spouses Form PH-4280.pdf
- Expedited Licensure for Military Member Form PH-4279.pdf
- Director Level Credentialing Agencies
- New Emerging Technologies