MDL Form 449 –
Candida auris Colonization Screening
Electronic Submittal Form Instructions
Use Lab Form 449 - Candida auris Colonization Screening (PDF) to submit specimens. Use the following steps to enter information for the submission of each specimen.
NOTE: We are unable to process samples with inadequate information.
All
Candida auris colonization screening testing must be approved by CDPH’s HAI Program
PRIOR to submission. Specimens submitted without approval will not be tested.
1. On page one, under “Select Test Requisition”, use the pull down menu to select Lab Form “
Candida auris Colonization Screening-449”. Provide all necessary information on page 1. For directions on how to fill out the fields on page 1, please refer to the “
General Specimen Submission Page 1 Instructions ” page.
2. In addition to the fields listed s required under the link above, for MDL form 449, it is
REQUIRED that the following fields be filled in:
2.1. Field 9 (Ethnicity)
2.2. Field 10 (Race)
2.3. Field 11 (Pregnancy Status)
2.4. Field 12 (Patient Street Address)
2.5. Field 13 (City)
2.6. Field 14 (County)
2.7. Field 15 (State)
2.8. Field 16 (Zip)
2.9. Field 41 (Clinical History)
3. The following values specific to
C. auris colonization screening test requisitions should be entered:
3.1. For Field 34 (Material Submitted) select
3.2. For Field 37 (Source) select “Swab of axilla and groin”
3.3. For Field 39 (Test(s) Requested) enter “C. auris colonization screening”
4. Under Submitting Laboratory, please enter the facility name in “Name” and
be sure to enter a “Submitter Specimen #.” This can be an encounter level or test order generated unique number to identify the specimen. If your facility doesn’t have an automatically generated number to use for this field, please just number them (eg. 1, 2, 3, …etc). This is a required field for our logging system and for reporting of positive test results.
5. Follow the instructions below to provide additional information on page 2 “Candida auris Colonization Screening-449 – Additional Information":
5.1. Record the Original Healthcare Facility from which the specimen was collected, if different from the submitting facility.
5.2. Indicate the Healthcare Facility Type of the facility where the specimen was collected.
5.3. REQUIRED Indicate the local health jurisdiction of the facility where the specimen was collected.
If the local health jurisdiction is a city jurisdiction (e.g. City of Long Beach), use the dropdown to select the county to which the city jurisdiction belongs (e.g. Los Angeles County). Write in the city jurisdiction on page 2 after printing.
5.4. Record the contact information for the point of contact.
5.5. Print the completed
Lab Form 449 front to back. The document is formatted for 2-sided printing.
5.6. Before shipment, insert the completed Lab Form 449 and all attachments between the inner and outer shipping containers.
5.7. Packaging and shipping: The submitter is responsible for making sure that all samples are packaged and shipped according to the current federal and state packaging and shipping regulations for “Infectious substance, Category A” and/or “Biological substance, Category B”.
6. Additional considerations when submitting samples:
6.1. Clinical specimens should be appropriately sealed to prevent leakage during transport.
6.2. Label sample tube with at least two identifiers (i.e. the patient’s name, submitter lab number, date of birth) and the date collected.
6.3. For safety, all submitted sample tubes must have a tightened screw cap secured in place using tape/Parafilm.
6.4. Before shipment, insert the completed Lab Form 449 and all attachments between the inner and outer shipping containers.
6.6. If you have any questions regarding sample submission, call the MDL for guidance – 510-412-3700.