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    Laboratory Services Section
    MC 1947
    PO Box 149347 Austin, TX 78714-9347
    1100 W. 49th Street
    Austin, TX 78756-3199

    Phone: (512) 776-7318
    Fax: (512) 776-7294

    Phone Us Toll Free at:
    (888) 963-7111, ext. 7318

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Letter Revised F40-A and F40-B Specimen Submission Forms

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State of Texas Seal

TEXAS DEPARTMENT OF STATE HEALTH SERVICES

DAVID L. LAKEY, M.D.
COMMISSIONER

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
TDD: 1-800-735-2989

 

 

   

October 29, 2012

RE:  Revised F40-A and F40-B Specimen Submission Forms

Dear Submitter,

The Laboratory Services Section has revised the F40-A and F40-B Specimen Submission Forms. The forms have been updated to reflect the testing additions and deletions according to our new fee schedule.

Enclosed you will find a new master copy of the revised Specimen Submission forms and a copy of the form’s instructions. Please verify that your submitter information on the Specimen Submission forms is correct and up-to-date.  If it is not, please fax a copy of the enclosed form with the corrections to (512) 776-7533.

Discard all old DSHS Laboratory specimen submission forms that are listed below:

OLD FORM                           Comments

F40-A (AUG 2011)                - Replaced with F40-A (NOV 2012)

F40-B (AUG 2011)                - Replaced with F40-B (NOV 2012)

The new specimen submission forms are:                                 

NEW FORM                          Comments

F40-A (NOV 2012)                - for South Texas Laboratory (STL) chemistry specimens

F40-B (NOV 2012)                - for STL microbiology specimens

If you have questions and/or comments, please contact Susan Hoffpauir at 1-888-963-7111 ext 6030. Thank you for your cooperation in this matter.

Sincerely,

Grace Kubin, Ph.D.

Director, Laboratory Services Section

Last updated October 30, 2012