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VRDL Specimen Submittal Forms

 

  • Encephalitis
  •            Neurologic Surveillance Testing Case History Form (PDF)

               Neurologic Surveillance Testing - Instructions for Sending Specimens (PDF)

               Neurologic Surveillance Testing - Specimen Submittal Form (PDF)

     

  • Enterovirus
  •            Outpatient HFMD Case Report (Word)

               Hospitalized Enterovirus Case Report Form (PDF)

               Enhanced Enterovirus Surveillance - Epi Info and Submittal Form (PDF)

     

  • Gastroenteritis
  •            Norovirus Labortatory Network (NLN) Guidance for 2013-2014 Norovirus Season (PDF)

               Norovirus Outbreak – Group Specimen Submittal Form for Stool Samples (PDF)

               Confirmed Norovirus Outbreak Submittal Form For Strain Typing (PDF)

               Unexplained Gastroenteritis Outbreak Specimen Submittal Form (PDF)

     

  • Rabies: Animal-- (For suspect human rabies, consult Neurologic Surveillance Testing - Instructions for Sending Specimens)
  •            Rabies virus Strain Typing and Bat ID Specimen Submittal Form (PDF)

               Rabies virus – Specimen Submittal Form for Suspected Rabid Animals (PDF)  

     

  • Respiratory
  •            Isolate for Identification or Strain Typing Specimen Submittal Form (Non- influenza) (PDF)

               Influenza Reference Examination Submittal Form (PDF) (Use for isolates) 

               Influenza and  Respiratory Individual Specimen Submittal Form (Use for original clinical specimens) (PDF)

               Hantavirus Case History and Specimen Submittal Form (PDF)

               Pediatric Influenza Specimen Submittal Form (PDF)

               Respiratory Fatal Case Submittal Form (PDF)  (Word)

               Respiratory Outbreak – Group Specimen Submittal Form (PDF)

               Respiratory Outbreak from a Long Term Care Facility – Group Submittal Form (PDF)

               Severe Illness Laboratory Surveillance (SILS) Specimen Submittal Form (Word)

               Non-Influenza Respiratory Disease (NIRD) Surveillance Submittal Form (PDF)

     

  •  Retrovirus      

  •            HIV Submittal Form (Antibody & Antigen Testing) (PDF)

               HTLV Antibody Tests Form (PDF)

     

  • Vaccine Preventable-- (For measles, rubella or varicella, use General Purpose Specimen Submittal Form)
  •            Mumps Virus Specimen Collection Form (PDF) 

               General Purpose Specimen Submittal Form (Word) 

               Vaccine Preventable Reference Examination Submittal Form (for isolates of lab confirmed specimens) (PDF) 

               For original specimens that have not been tested, use the General Purpose Specimen Submittal Form

     

  • West Nile Virus
  •            West Nile Virus Testing - Specimen Submittal Form for Hospital Laboratories (PDF)

               West Nile Virus Testing - Specimen Submittal Form for Public Health Laboratories (PDF)

     

  • General   
  •            General Purpose Specimen Submittal Form (Word) 

     
     
    Last modified on: 5/6/2014 3:10 PM