How to Make Changes to Your 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 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 instructions to complete and submit all the requested information including the List of Tests Performed in the Facility.
For a change of ownership you must complete the Change of Ownership Packet. Make sure you follow instructions to complete and submit all the requested information.
For laboratories with multiple sites, you should complete the CLIA Multiple Sites Form for adding and deleting sites from your certificate.
For termination of a CLIA certificate there is not a specific form to complete. To terminate a CLIA certificate 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.
For any other change you should contact the state CLIA Program at email@example.com or (225) 342-9324.
Once the information is complete you may submit via email to firstname.lastname@example.org, by fax to (225) 342-9349, or mail to CLIA Laboratory Program, P O BOX 3767, Baton Rouge, LA 70821.
NOTE: CMS does not automatically issue new CLIA certificates when changes are made to the information for your CLIA certificate. However, documentation is sent to the laboratory from the state via email, fax, or mail as verification of the updates made.