Idaho Bureau of Laboratories
Laboratory Improvement Section
208-334-2235 ext. 246
1. All items must be completed. If you have any questions, please call the Laboratory Improvement Section at 208-334-2235 ext. 246.
2. The Laboratory Director must be a person qualified under the CLIA regulations. Most physicians will qualify as the director of their office labs.
3. The contact person should be someone familiar with the laboratory's operations and the person who will be contacted with any questions about this form.
4. The technical consultant position is only required for full certificate laboratories. This person must qualify under the CLIA regulations for technical consultant.
5. The clinical consultant must be an MD or DO who qualifies under the CLIA regulations to provide consultation to a full certificate laboratory.
6. A copy of your completed form will be emailed to the email address provided upon form completion. Retain this for your records.
By submitting this form, you are certifying that the information contained herein is true and correct to the best of your knowledge.