|DAVID L. LAKEY, M.D.
1100 W. 49th Street • Austin, Texas 78756
P.O. Box 149347 • Austin, TX 78714-9347
1-888-963-7111 • http://www.dshs.state.tx.us
August 11, 2008
RE: Revised G-1B, G-1C, G-2A, G-2B, F40-A, and F40-B Specimen Submission Forms
Effective September 2008, the Texas Department of State Health Services (DSHS) Laboratory Services Section will be changing the G-1B, G-1C, G-2A, G-2B, F40-A, and F40-B specimen submission forms, including changes in the Payor Source sections.
Enclosed you will find a new master copy of the new Specimen Submission forms and a copy of the form’s instructions. Please be aware that the Ordering Physician’s name and National Provider Identifier (NPI) number must be provided in the Ordering Physician Information section. Please verify that your submitter information on the Specimen Submission forms is correct and up-to-date. If it is not, please fax the Specimen Submission form with the needed corrections to (512) 458-7533.
Discard all old DSHS Laboratory specimen submission forms that are listed below:
The new specimen submission forms are:
If you have any other questions and/or comments, please contact Susan Hoffpauir at 1-888-963-7111 ext. 6030. Thank you for your continued support.
Susan U. Neill, PhD, MBA
Director, Laboratory Services Section