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Print Copy of Clia Certificate  Form

Print Copy of Clia Certificate Form

Use a copy of clia certificate template to make your document workflow more streamlined.

Department of Health and Human Services DHHS Centers for Medicare Medicaid Services CMS to assess fees to cover all costs of administering the program including registering laboratories issuing certificates and conducting onsite surveys. If changes are required to your certificate you may make them on the reverse side of this form and mail it to the state agency listed below. For more information about CLIA visit our website at www. cms. hhs. gov/CLIA or contact the state agency with any...
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