Forms that are available without requesting a sample kit are listed below. If you cannot find a form below, and/or a form is referenced on another page but no link is provided, then it is likely a form that is available only with a sample kit. Newsletters and bulletins have moved to laboratory improvement.
Please complete a CDC Submission Form for each specimen type being submitted for testing. Open the appropriate submission form by clicking on the specimen type listed below. Complete the following sections in each form submitted with each specimen type: Patient Information, Specimen collected date, Original Submitter, Brief Clinical Summary, State of Illness, Travel History, and Relevant Immunization History.
Important, read first!! You need to open and work with the files linked below using the free Adobe Reader (deselect the "Optional offers"). Unless you are certain you are using a browser with Adobe Reader as the enabled PDF viewer plug-in, we recommend you download the form, save it to your machine, and then open with Adobe Reader. Why? The default PDF viewer plug-in for certain browsers, such as Chrome and Firefox, will not open the file.
|Specimen Type||Form Name; Posted Date|
|Acute CSF (< 7 days post onset of symptoms)||CDC-5034-CSF Acute; 02/22/16|
|Acute Serum (< 7days post onset of symptoms)||CDC-5034-Serum Acute; 02/22/16|
|Amniotic Fluid||CDC-5034-Amniotic Fluid; 02/22/16|
|Convalescent Serum (> 7 days post onset of symptoms)||CDC-5034-Serum Conv 8+ Days PO; 02/22/16|
|Cord Blood||CDC-5034-Cord Blood; 02/22/16|
|Placental Tissue||CDC-5034-Placental Tissue; 02/22/16|
|Form Number||Name; Posted Date|
|CDC 50.34 DASH Form
(Summary of Changes)
Important, read first!! You need to open and work with this file using the free Adobe Reader (deselect the "Optional offers"). Unless you are certain you are using a browser with Adobe Reader as the enabled PDF viewer plug-in, we recommend you download the form, save it to your machine, and then open with Adobe Reader. Why? The default PDF viewer plug-in for certain browsers, such as Chrome and Firefox, will not open the file.
|CDC 50.34 DASH Form; 12/06/16|
|CDC 50.34 Instructions/Training||FEMB Specimen Submission Form Training|
|DHHS-1188||Rubella Serology; 08/17/16|
|DHHS-1245||Parasitology Form; 08/17/16|
|DHHS-1247||Mycobacteriology (TB) Form; 08/17/16|
|DHHS-1614||Rabies Examination Form; 04/27/15|
|DHHS-1814||Food Environmental Sample Collection Report Form; 04/01/13|
|DHHS-1859WB||Hemoglobin Electrophoresis -- Whole Blood; 08/17/16|
|DHHS-2010||Mycology Form; 08/17/16|
|DHHS-2887||Public Water Supply Analysis; 04/24/13|
|DHHS-3390||Enteric Bacteriology Form; 08/17/16|
|DHHS-3431||Virology Form; 08/18/16|
|DHHS-3445||Special Serology Form; 08/18/16|
|DHHS-3446||Syphilis Serology Form; 08/17/16|
|Blood Lead Analysis Form; 10/19/16; Prenatal testing available only to local health departments|
|DHHS-3722||Hepatitis Serology Form; 08/23/16|
|DHHS-4011||Chlamydia/Gonorrhea Detection Form; 08/18/16|
|DHHS-4121||Special/Atypical Bacteriology Form; 08/17/16|
Use this form to sign up as a new specimen submitter:
New Client Information Form (PDF, 113 KB)
For current submitters, use this form to change contact information (Name, EIN, Address, etc):
Client Change of Information Form (PDF, 80 KB)
Instructions for reviewing laboratory results online (PDF, 38 KB)
Complete all required information on form and submit proof of identification as requested on page 2 of form. Mail or fax to 919-715-8610. The Laboratory is not responsible for interpreting laboratory test results.