How to Make Changes to CLIA Certificate

All changes made to the information for your CLIA must be submitted within 30 days of the change to the Louisiana CLIA Program.  All changes must be submitted in writing. For changes in the demographic information, you should complete the CLIA Demographic Change Form. 

For a change in Laboratory Director, you must complete the Clinical Laboratory Improvement Amendments (CLIA) Application for Certification marked Other. For any certificate type other than waiver, also submit the credentials of the new laboratory director.

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For a change in certificate type, you must complete the Clinical Laboratory Improvement Amendments (CLIA) Application for Certification marked for a change in certificate type.  Make sure you follow the instructions to complete and submit all the requested information, including the List of Tests Performed in the Facility. 

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For laboratories with multiple sites, you should complete the CLIA Multiple Sites Form for adding and deleting sites from your certificate. 

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For termination of a CLIA certificate, there is no specific form to complete.  You should submit the specific information in writing.  The request should include the specific CLIA Identification Number, the reason for termination, and the effective date of the termination.

NOTE:  CMS does not automatically issue new CLIA certificates when changes are made to the information for your CLIA certificate.  However, all active CLIA certificates are accessible for review using CMS Laboratory Demographic Lookup (QCOR).