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Forms

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.

 Zika Testing – CDC Submission Forms

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
Saliva CDC-5034-Salival; 02/22/16
Urine CDC-5034-Urine; 02/22/16

 Specimen Submittal Forms

Form Number Name; Posted Date
CDC 50.34 DASH Form

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; 12/05/15
CDC 50.34 Instructions/Training external link FEMB Specimen Submission Form Training
  • HIV Testing Report Form; 02/17/15
  • HIV Testing Report Form Instructions; 02/17/15
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; 07/21/16; 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

Client Information Forms

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 Accessing Clinical Lab Results from the Website

Instructions for reviewing laboratory results online (PDF, 38 KB)

Patient Request Form to Obtain Completed Laboratory Results

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.

Patient Request for Release of Completed Laboratory Results (PDF, 71 KB)

Bioterrorism Forms

Mailroom Supply Requisition Forms

Order Supplies from Mailroom Online

N.C. Drinking Water Lab Certification

Documents

Safety Data Sheets