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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.
09/21/17: Instructions for Filling Out Specimen Submission Forms (PDF, 16 KB)
| 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; 12/08/17 |
CDC 50.34 Instructions/Training  |
FEMB Specimen Submission Form Training |
| DHHS-1111 |
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| DHHS-1188 | Rubella Serology; 08/15/17 |
| DHHS-1245 | Parasitology Form; 08/15/17 |
| DHHS-1247 | Mycobacteriology (TB) Form; 08/15/17 |
| 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; 08/15/17 |
| DHHS-2010 | Mycology Form; 08/15/17 |
| DHHS-2887 | Public Water Supply Analysis; 04/24/13 |
| DHHS-3390 | Enteric Bacteriology Form; 08/15/17 |
| DHHS-3431 | Virology Form; 08/18/16 |
| DHHS-3445 | Special Serology Form; 08/29/17 |
| DHHS-3446 | Syphilis Serology Form; 08/15/17 |
| 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; 08/14/17 |
Use this form to sign up as a new specimen submitter:
New Client Information Form (PDF, 74 KB)
For current submitters, use this form to change contact information (Name, EIN, Address, etc):
Client Change of Information Form (PDF, 55 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.
Patient Request for Release of Completed Laboratory Results (PDF, 71 KB)
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Updated: May 9, 2018