How to Make Changes to your CLIA Certificate
 

*Effective August 2019, Due to new CMS requirements an updated CMS 116 may be required to complete requested changes

Name, Address, Tax ID, Phone Changes
Please notify our department in writing. Include the CLIA number, the old information, the new information and the effective date of the change. This notification should be signed by someone with authority to make changes.

Laboratory Director Changes

Certificate of Waiver - Please notify us in writing, include: the CLIA number, the name and address of the facility, the old director/new director, and the effective date of the change. This notification must be signed by the new laboratory director. In certain instances, an updated CMS-116 may be required if requested.

Certificate of Provider Performed Microscopy (PPMP) - Complete ALL sections of the CMS-116 CLIA application. Please include a copy of the new director’s physical medical license.

Certificate of Accreditation -  As of January 2019, our office will no longer be processing laboratory director changes for Certificate of Accreditation labs. These changes must be completed by the laboratory's Accrediting Organization.

Certificate of Compliance - Complete ALL sections of the CMS-116 CLIA application. Please include a copy of the new director’s credentials and a copy of the physical medical license if applicable.

Certificate Type Changes
For all certificate type changes, all sections of the CMS 116 CLIA Application must be completed and signed by the laboratory director.

Completed 116 applications can be e-mailed to BCHS-CLIA@michigan.gov. Always indicate your CLIA number in the subject line of the email.