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Get Clia Waiver Application California 2020-2025
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How to fill out the Clia Waiver Application California online
Filling out the Clia Waiver Application is an essential process for laboratories in California seeking a certificate of waiver. This guide provides clear, step-by-step instructions to help you complete the application accurately and efficiently.
Follow the steps to complete the Clia Waiver Application online.
- Click ‘Get Form’ button to obtain the application form and open it for editing.
- In the first section, provide the name of your laboratory, the tax identification number, and the full address including street number, city, state, and ZIP code, ensuring all information aligns with your CLIA provider number.
- Enter your contact information, including the telephone number, fax number, and email address. Verify the CLIA provider number matches your records.
- Select the type of certificate you are applying for by checking the appropriate box for either a Certificate of Waiver or Provider Performed Microscopic Procedure.
- Indicate the ownership type of your laboratory. Provide the legal name along with the personal address of the owner or all members of a partnership, ensuring accurate completion of this section.
- If your laboratory is operated under a corporation, list the names and addresses of officers, directors, and shareholders holding a 5% or more interest. Use a supplementary sheet if necessary to include all required information.
- Document the laboratory directors, including their names and personal addresses, ensuring you list all individuals and their hours on site as required.
- Ensure that the declaration statement at the end of the application is signed by both the laboratory director and the owner, along with their printed names, titles, and the date of signing.
- After completing the application, review all entries for accuracy. You can then save your changes, download, print, or share the form as needed.
Complete your Clia Waiver Application online today for a streamlined submission process.
To bill for a Clia-waived test, you must ensure proper documentation and coding for the services provided, typically using specific codes assigned to these tests. It's important to keep accurate records to support your billing claims. For more details on best practices for billing and compliance related to your Clia Waiver Application California, turn to uslegalforms for clarity.
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