Step 2 - Ensure that you have the correct application type identified

There are four (4) applications types:

Types 1 - 3 are contained within the same application form. There is a place on the applicaiton form to identify the type of application.

  1. Initial applications are filed by entities seeking to establish a laboratory and by laboratories that had to cease testing because an application to renew the license was not received by the Agency before the license expired. Initial applications are also filed by existing laboratories that perform only waived testing seeking to upgrade a federal CLIA Certificate of Waiver to a laboratory that performs non-waived testing. NOTE: Agency letters are often sent to applicants by certified mail. All letters are sent to the mailing address provided on the application. After submitting your application, please be prepared to accept and sign for any certified mail sent by the Agency. If the certified letter is sent back to the Agency as undeliverable or, in the case of those sent to the post office box, not accepted or not picked up, the application could be denied.
  2. Change of ownership applications must be filed prior the effective date of the change. If they are not, then the laboratory will be operating without a license, which is a criminal offense and subject to fine. NOTE: Change in Ownership means an event in which the licensee sells or otherwise transfers its ownership to a different individual or entity as evidenced by a change in federal employer identification number or taxpayer identification number, or an event in which 51 percent or more of the ownership, shares, membership, or controlling interest of the licensee is in any manner transferred or otherwise assigned. This does not apply to a licensee that is publicly traded on a recognized stock exchange. [see section 408.803(5), Florida Statutes]
  3. Renewal applications are filed by existing laboratories seeking to renew their license. If your license has expired, a renewal application will not be accepted because an initial application is required (see "initial applicaitons" above).

Type 4, Addition of Specialty/Subspecialty. If you wish to add or remove a specialty or subspecialty, the Addition of Specialty/Subspecialty application should be filed. This is a separate application form. Fees may be required for this application depending on what is being added and the volume to testing being preformed.

4. Recommended form: (writable PDF form)
http://ahca.myflorida.com/MCHQ/Corebill/ClinicalLab_Non-Waived/Lab_Specialty_application_59A-7.pdf


Reporting Medicaid Fraud