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Clia waiver california 2026
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- Click ‘Get Form’ to open the CLIA Waiver California application in the editor.
- Begin by filling out the laboratory name, tax ID number, and address in the designated fields. Ensure that this information matches your CLIA Provider number.
- Next, provide your city, telephone number, fax number, and email address. Double-check for accuracy to avoid processing delays.
- Indicate the type of certificate you are applying for by checking the appropriate box. This includes options like Certificate of Waiver or Provider Performed Microscopic Procedure.
- Complete the ownership section by selecting your type of ownership (individual, partnership, corporation) and providing the necessary names and addresses as required.
- List all laboratory directors along with their personal addresses. Make sure to include hours per week they will be on-site.
- Finally, ensure that both the laboratory director and owner sign and date the application before submission.
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