How to Apply for a CLIA Certificate

To obtain CLIA certification for laboratory testing in the state of Louisiana, you must complete the Clinical Laboratory Improvement Amendments (CLIA) Application for Certification, Form CMS-116 along with the List of Tests Performed in the Facility.  Both forms are required in order to approve your facility for testing.

Follow the instructions provided with the application in completing the requested information.  All requested information must be submitted for the application to be processed.  The specific sections of the application which must be completed are indicated next to the Type of Certificate Requested on the bottom of page one of the application.

The Type of Certificate Requested is determined by the specific testing you perform.  The link provided will assist you in determining the specific certificate required based on the testing you perform.  Once you have determined your test menu, indicate the specific certificate type on the bottom of page one.

If you are applying for a Certificate of Provider Performed Microscopy Procedures (PPM), Certificate of Compliance, or a Certificate of Accreditation, you must submit documentation of the qualifications of the Laboratory Director along with the application and the List of Tests.

NOTE: DO NOT send fees with an initial application. DO NOT send CLIA fees to the Louisiana State Agency.

Once the information is complete you may submit via email to alexa.little@la.gov or mail to CLIA Laboratory Program, P O BOX 3767, Baton Rouge, LA  70821.