Clia waiver california 2026

1. Click ‘Get Form’ to open the CLIA Waiver California application in the editor.
2. 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.
3. Next, provide your city, telephone number, fax number, and email address. Double-check for accuracy to avoid processing delays.
4. 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.
5. Complete the ownership section by selecting your type of ownership (individual, partnership, corporation) and providing the necessary names and addresses as required.
6. List all laboratory directors along with their personal addresses. Make sure to include hours per week they will be on-site.
7. Finally, ensure that both the laboratory director and owner sign and date the application before submission.

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