Clinical Laboratory Improvement Amendments (CLIA): Forms

This page includes forms related to clinical laboratories in Wisconsin. Email dhsdqaclia@dhs.wisconsin.gov if you have questions about these resources.

Forms

• CLIA Application for Certification - CMS-116 (PDF) (also see the Federal CMS CLIA website)
• Laboratory Application for Approval to Perform Implied Consent Wis. Stat. 343.305(6) Testing, F-62501
• Analyst Application for Approval to Perform Implied Consent Wis. Stat. 343.305(6) Testing, F-62502

Licensing information

• Alcohol, Controlled Substance, Controlled Substance Analog Testing for Analysts
• Alcohol, Controlled Substance, Controlled Substance Analog Testing for Laboratories
• Clinical Laboratory Improvement Amendments of 1988 (CLIA) Application