Forms
Fees
Order Forms for Laboratory Mailing Containers and Supplies
Phone (512) 776-7661
Fax (512) 776-7672
Some of these forms are in PDF format. See the file viewing information. Supplies are provided only for testing performed at the DSHS Laboratory.
Test Request Form Samples and G-9 Form - Laboratory Services
Phone No. (512) 776-7578
FAX No. (512) 776-7533
Note: Unless otherwise noted, these are sample forms only. To receive specimen submission forms with your submitter identification, please request forms by email or by phone. If you do not yet have a submitter identification number, please complete and submit the Submitter Identification (ID) Number Request Form (PDF 27kb).
When printing out the sample forms below, you may notice that some of the section headings in white type do not print correctly. In that case, choose File > Print from your browser menu, then in the Print dialog box, check the option that says "Print as image." This option is located directly underneath the "Properties" button. Then click the Ok button. The sample form should then print normally.
Obtaining Specimen Submission Forms by email
Email request to: Laboratory Forms. Please provide required information below when requesting forms by email.
Required Information
|
G-2A or G-2B Microbiology Submission Forms
The following information is needed to request a G-2A and or G-2B submission form:
- Submitter Number
- Submitter National Provider Identification Number (NPI)
- Provider Name
- Mailing Address
- City, State, Zip
- Phone Number
- Fax Number
- Contact person name
- Physician Name
- Physician's NPI Number
- Physician's UPIN Number
- Email address
G-1B Specimen Submission Form and G-THSTEPS Specimen Submission Form
The following information is needed to request a G-1B or G-THSTEPS submission form:
- Texas Provider Identifier Number (TPI)
- National Provider Identification Number (NPI)
- Provider Name · Mailing Address
- City, State, Zip
- Phone Number
- Fax Number
- Contact person name
- Physician Name
- Physician's NPI Number
- Physician's UPIN Number
- Email address
|