Arizona

Arizona Department of Health Services Authority, Public Health Division. Clinical Laboratories.              https://azlibrary.gov/sla/agency_histories/clinical-laboratories

• CMS Notification Form Requirements
  • View to see which form(s) you will need.
• CMS-116 CLIA Application
  • It can also be found on the Centers for Medicare & Medicaid Services CLIA page under “How to Apply for CLIA Certificate” located on the left side.
• Facility Status Changes Form
  • Facilities that have a change in status must complete the following form and email it to cliaaz@azdhs.gov or fax it to 602-364-0759.
• Disclosure of Ownership and Control Interest Form
  • Facilities that have a change in ownership must complete the following form and email it to cliaaz@azdhs.gov or fax it to 602-364-0759.

For a detailed description of the CLIA program, types of Certificates, the current CLIA regulations, the CLIA fee schedule, and other CLIA-related inquiries please visit CLIA.

Resources

• Pay CLIA fees:
  • Online
  • Mail a check to the PO Box address listed on the fee coupon:
    CLIA Laboratory Program
    P.O. Box 3056
    Portland, OR 92708-3056
• Revised & Replacement Certificate Fees
• CLIA Regulations & Interpretive Guidelines
• Small Business Bill of Rights
• Laboratory Demographics Lookup

Online Access to CLIA Certificates

CMS is now making CLIA certificates available online at no cost via the QCOR Lookup Tool.  All certificates generated after September 27, 2023 should be available for download.  Click HERE to access the Tool and choose “CLIA Laboratory Lookup” from the left menu bar (2nd option from the top).  When you click the entry for the laboratory, a box containing the laboratory information and a link to the certificate will pop up in a new window.