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Louisiana Department of Health & Hospitals | Kathy Kliebert, Secretary

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Applications/Forms

Tuesday, January 01, 2013
Health Unit Excuse Form

Health Unit appointment excuse form.

Thursday, October 11, 2012
How to Apply for a CLIA Certificate

To obtain CLIA certification for laboratory testing in the state of Louisiana, you must complete the Clinical Laboratory Improvement Amendments (CLIA) Application for Certification, Form CMS-116 along with the List of Tests Performed in the Facility. Both forms are required in order to approve your facility for testing.

Thursday, June 02, 2011
Hospital Transplant Unit/Center Packet

The instructions and forms in this packet are designed to assist providers in submitting the required information to add a transplant unit.

Tuesday, April 26, 2011
Education and Experience Update Form

Tuesday, April 26, 2011
Operator Certificate Application

Wednesday, March 30, 2011
Adult Residential Care Provider License Application

Effective July 1, 2010 the Louisiana Department of Health and Hospitals, Health Standards Section will license Adult Residential Care Providers.