Clinical Laboratory Certification

Applications

  • Check out our Ebola Virus Disease page which addresses a number of commonly asked questions related to sample collection and submission.
  • CLIA Certification Certificates are now available.
  • What is a public health laboratory? Watch this animated video to learn how public health laboratories protect the public against diseases and other health hazards.

Questions concerning applications may be directed to (602) 364-0726. Additional information concerning the CMS/CLIA programs may be obtained at CLIA

  • CMS-116 CLIA Application Form
    • The application should be completed and sent to the Office of Laboratory Services, ATTN: CLIA, 250 N. 17th Avenue, Phoenix, AZ 85007 OR Faxed to (602) 364-0759.
    • Once the application has been received and processed, an invoice will be generated from CMS. Checks should be made out to CLIA Laboratory Program and should include the CLIA number on the check to ensure that the payment is accredited to the correct account.Do not send payments to the state.
    • Good Laboratory Practices for Waived Laboratories
    • Applications are not complete until all forms are filled out and submitted.
  • Arizona Health Screening Registration Form
    • The registration should be completed and sent to the Office of Laboratory Services, ATTN: CLIA, 250 N. 17th Avenue, Phoenix, AZ 85007 OR Faxed to (602) 364-0759.
    • Applications are not complete until all forms are filled out and submitted.
  • Facility Status Changes Form
    • Facilities that have a change in status must complete the following form and fax it to the Office of Laboratory Services at (602) 364-0759.
  • Disclosure of Ownership and Control Interest Form
    • Facilities that have a change in ownership must complete the following form and fax it to the Office of Laboratory Services at (602) 364-0759.

Contact Denise Barbeau to request an application.

Note: All files are PDF format.