Birthing Center Renewal Application
Children’s Community–Based Health Care Center Initial Application
Children’s Community–Based Health Care Center Renewal Application
Community-Based Residential Rehabilitation Center Initial Application
Community-Based Residential Rehabilitation Center Renewal Application
Postsurgical Recovery Care Renewal Application
Subacute Care Renewal Application
Children’s Community–Based Health Care Center Initial Application
Children’s Community–Based Health Care Center Renewal Application
Community-Based Residential Rehabilitation Center Initial Application
Community-Based Residential Rehabilitation Center Renewal Application
Postsurgical Recovery Care Renewal Application
Subacute Care Renewal Application
Ambulatory Surgical Treatment Center License Renewal Application
Ambulatory Surgical Treatment Center Medicare Certification
Ambulatory Surgical Treatment Center Project Submission Form
Ambulatory Surgical Treatment Center Construction Award Form
Facility Information Change Form
Certifications for Request for Inspection
Occupancy Matrix 4A - UL Assembly Ratings
Occupancy Matrix 4B - Through Wall/Floor Penetrations
Occupancy Matrix 4C - Interior Finishes
Occupancy Matrix 4D - Project Cost and Fee Verification
Occupancy Matrix 4E - Fire, Smoke, Fire/Smoke Damper
Occupancy Matrix 4F - Air Balancing
Temporary Occupancy Policy
Healthcare Facilities Complaint Form
Health Care Professional Credentialing and Data Gathering Form
Health Care Professional Update Data Gathering Form
Health Care Professional Recredentialing and Data Gathering Form
Ambulatory Surgical Treatment Center Medicare Certification
Ambulatory Surgical Treatment Center Project Submission Form
Ambulatory Surgical Treatment Center Construction Award Form
Facility Information Change Form
Certifications for Request for Inspection
Occupancy Matrix 4A - UL Assembly Ratings
Occupancy Matrix 4B - Through Wall/Floor Penetrations
Occupancy Matrix 4C - Interior Finishes
Occupancy Matrix 4D - Project Cost and Fee Verification
Occupancy Matrix 4E - Fire, Smoke, Fire/Smoke Damper
Occupancy Matrix 4F - Air Balancing
Temporary Occupancy Policy
Healthcare Facilities Complaint Form
Health Care Professional Credentialing and Data Gathering Form
Health Care Professional Update Data Gathering Form
Health Care Professional Recredentialing and Data Gathering Form
CMS-116 CLIA Application
Health Wellness Event Requirements and Approval Request Form (for collection of specimens ONLY)
Complaint Form and Instructions
Disclosure or Change of Ownership and Tax ID
Disclosure of CLIA Certificate Shared Lab
Health Screening Event Requirements and Approval Request Form (for TESTING and COLLECTION of specimens)
Laboratory Name, Address and Director Change
Tissue and Sperm Bank Registration
Specialty, Subspecialty, and Test/Assay Change
How to Obtain a CLIA Certificate (CMS*)
How to Obtain a CLIA Certificate of Waiver (CMS)
Complaints from the Public (CMS)
Laboratory Director Responsibilities (CMS)
Laboratory Personnel Qualifications
Laboratory Record Retention Requirements
List of CPT Codes PPM Tests (CMS)
List of CPT Codes Waived Tests (CMS)
List of CPT-4 and HCPCS Codes Non-waived Tests subject to edits (CMS)
Making Changes to Your CLIA Certificate
Survey Operation Manual – Appendix C
Health Wellness Event Requirements and Approval Request Form (for collection of specimens ONLY)
Complaint Form and Instructions
Disclosure or Change of Ownership and Tax ID
Disclosure of CLIA Certificate Shared Lab
Health Screening Event Requirements and Approval Request Form (for TESTING and COLLECTION of specimens)
Laboratory Name, Address and Director Change
Tissue and Sperm Bank Registration
Specialty, Subspecialty, and Test/Assay Change
How to Obtain a CLIA Certificate (CMS*)
How to Obtain a CLIA Certificate of Waiver (CMS)
Complaints from the Public (CMS)
Laboratory Director Responsibilities (CMS)
Laboratory Personnel Qualifications
Laboratory Record Retention Requirements
List of CPT Codes PPM Tests (CMS)
List of CPT Codes Waived Tests (CMS)
List of CPT-4 and HCPCS Codes Non-waived Tests subject to edits (CMS)
Making Changes to Your CLIA Certificate
Survey Operation Manual – Appendix C