Medical Laboratories Forms



APPLY ONLINE FOR ALL MEDICAL LABORATORY & LABORATORY PERSONNEL APPLICATIONS by going to the Division's online licensing system at:  https://nvdpbh.aithent.com/login.aspx 

Medical Laboratory and Laboratory Personnel applications below should only be completed and mailed in if you are unable to submit an electronic application by clicking on the link above. 

 CLINICAL LABORATORY IMPROVEMENT AMENDMENTS (CLIA) FORMS 

LABORATORY SELF-ATTESTATIONS

      Exempt Laboratory Self-Attestation Checklist (used to prepare for inspections/self-audit your           laboratory) 

 ONLINE SUPPLEMENTAL FORMS (To be used only as directed when applying online via the online licensing system)

 

    Last Updated: 1/11/2017