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.
Instructions for Filling Out Specimen Submission Forms (PDF, 16 KB)
Form Number | Name; Posted Date |
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Important, read first!! If your browser's PDF viewer does not display the CDC DASH form (i.e., you see an error page), try right-clicking on the link and saving the file ("Save Link As" from the menu) to your computer, then opening the file from the location where you just stored it on your machine (e.g., your desktop) using a PDF viewer such as Adobe Reader (deselect the "Optional offers"). 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; 12/08/2020 |
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; 10/26/20 |
DHHS-3431 | Virology Form; 03/02/2020 |
DHHS CVD19 | COVID-19 Submission Form; 10/20/2020 |
DHHS-3445 | Special Serology Form; 03/12/19 |
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; 05/30/19 |
DHHS-4011 | Chlamydia/Gonorrhea Detection Form; 08/28/20 |
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)
Two forms are required for the NCSLPH to be permitted to release laboratory results to patients. The NCSLPH is not responsible for interpreting laboratory test results.
Order Supplies from Mailroom Online
Please click on links to view and print the safety data sheets (SDS) for information on potential hazards contained in media supplied by NCSLPH.
Kit Name | Media Name | Hazards |
---|---|---|
Bordatella pertussis | Regan Lowe | |
Viral testing | Viral Transport | |
Ova and parasite detection | ATS Para-Set 10% Buffered Formalin Fixative | |
Enteric culture | ATS Enteric Transport Media | |
MTMII Agar | Thayer Martin, Modified Agar |