Clinical Laboratory Improvement Amendments (CLIA): Forms

Portal outage

Routine system maintenance is happening on Sunday, January 11, 2026, at 9 p.m. for up to 3 hours. The DHS DQA Provider Portal and associated systems will be unavailable during this time. We appreciate your understanding and support.

This page includes forms related to clinical laboratories in Wisconsin. Email dhsdqaclia@dhs.wisconsin.gov if you have questions about these resources.

Forms

CLIA Application for Certification - CMS-116 (PDF) (also see the Federal CMS CLIA website)

Licensing information

Alcohol, Controlled Substance, and Controlled Substance Analog Testing Permits for Analysts
Alcohol, Controlled Substance, and Controlled Substance Analog Testing Permits for Laboratories

Portal outage

Forms

Licensing information

Glossary