Medical Laboratories Forms


School Districts Laboratory Application

In an effort to address the COVID-19 pandemic, the Federal Government through the Centers for Medicare and Medicaid Services (CMS), is moving forward with securing and distributing COVID-19 testing supplies to the K through 12 school system. To take advantage of this testing capability, each participating school district will be required to have a state of Nevada laboratory license and a Federal CLIA (Clinical Laboratory Improvement Amendments) certificate. For more information, click on the PDF linked below.


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)