Application must be made on a form prescribed by the department. Licenses must be issued to perform testing in one or more of the following categories or specialties: Histocompatibility; microbiology, including subcategories bacteriology, mycology, parasitology, virology; immunology or serology, including subcategories syphilis and nonsyphilis; chemistry, including subcategories routine, clinical microscopy or urinalysis and other, including toxicology; hematology, including coagulation; immunohematology, including subcategories blood group and Rh typing, Rh titers, cross matching, antibody detection and identification; pathology, including subcategories tissue, oral, diagnostic cytology; and radiobioassay. All applications must be accompanied by a license application fee. The application must contain the following information:
1. Name and location. The name and location of the medical laboratory;
2. Director and owners. The name of the director of the laboratory and the name of the owner or owners, if different;
3. Services. A description of the services provided by such medical laboratory; and
4. Other information. Such other information as the department may deem necessary or expedient in carrying out its powers and duties under this Act.