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.
Test Request Form Samples and Master Forms
Form #
|
Name |
| |
Program Descriptions for Laboratory Forms |
| |
Submitter Identification (ID) Number Request Form, revised 9/2013 (PDF 30kb) |
South Texas Laboratory
|
| F-14 |
| Order Form for General Laboratory Supplies MASTER, revised 7/2014 (PDF 85kb) |
| F40-A |
| Chemistry Specimen Submission Form Sample, revised 9/2013 (PDF 138kb) |
| F40-B |
| Microbiology Specimen Submission Form Sample, revised 9/2013 (PDF 138kb) |
| F40-C |
| Biothreat Specimen Submission Form MASTER, revised 7/2014 (PDF 111kb) |
| F40-D |
| Emergency Preparedness Specimen Submission Form MASTER, revised 9/2014 (PDF 67kb) |
| G-1B |
| Biochemistry and Genetics Specimen Submission Form Sample, revised 9/2014 (PDF 696kb) |
| G-THSTEPS |
| Texas Health Steps Specimen Submission Form Sample, revised 9/2013 (PDF 167kb) |
| G-2A |
| Serology Specimen Submission Form Sample, revised 9/2014 (PDF 648kb) |
| G-2B |
| Bacteriology and Parasitology Specimen Submission Form Sample, revised 9/2014 (PDF 646kb) |
| G-2V |
| Virology Specimen Submission Form Sample, revised 9/2014 (PDF 633kb) |
| G-MYCO |
Mycobacteriology / Mycology Specimen Submission Form Sample, revised 9/2013 (PDF 101kb) |
G-9
|
Laboratory Test for Rabies MASTER, revised 9/2013 (PDF 60kb) |
G-14
|
Mosquito Surveillance Adult / Larval Specimen Submission Form Sample, revised 9/2013 (PDF 69kb) |
| G-19 |
Water Bacteriology Specimen Submission Form Sample, revised 9/2013 (PDF 30kb) |
| G-22 |
Environmental / flouride / microbiological Specimen Submission MASTER, revised 9/2013 (PDF 32kb) |
| G-23 |
Food Sample Specimen Submission Form Sample, revised 9/2013 (PDF 61kb) |
| G-26 |
Uniform Analysis for TDCJ & TJJD Specimen Submission Form MASTER, revised 5/2014 (PDF 23kb) |
| G-27 |
Biothreat Environmental Specimen Submission Form Sample, revised 4/2013 (PDF 33kb) |
| G-27A |
Emergency Preparedness Specimen Submission Form Sample, revised 9/2014 (PDF 566kb) |
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
|