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.
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 11/2017 |
| | Remote Data Services Facility Security Agreement 2017 |
| | Remote Data Services User Agreement 2017 |
|
South Texas Laboratory |
| F-14 |
Order Form for General Laboratory Supplies – MASTER, revised 07/2014 |
| F40-A |
Chemistry Specimen Submission Form – Sample, revised 10/2017 |
F40-B F40-B |
Microbiology Specimen Submission Form – Sample, revised 09/2016 Spanish Version: Microbiology Specimen
Submission Form –
Sample, revised 09/2016 |
| F40-C |
Biothreat Specimen Submission Form – MASTER, revised 09/2016 |
| F40-D |
Emergency Preparedness Specimen Submission Form – MASTER, revised 09/2016 |
| G-1B |
Biochemistry and Genetics Specimen Submission Form – Sample, revised 10/2017 |
| G-THSTEPS |
Texas Health Steps Specimen Submission Form – Sample, revised 10/2017 |
| G-2A |
Serology Specimen Submission Form – Sample, revised 10/2017 |
| G-2B |
Bacteriology and Parasitology Specimen Submission Form – Sample, revised 10/2017 |
| G-2E | Epidemiological Studies and CDC Special Projects – Sample, revised 07/2018 |
| G-2V |
Virology Specimen Submission Form – Sample, revised 10/2017 |
| G-MYCO |
Mycobacteriology/Mycology Specimen Submission Form – Sample, revised 09/2016 |
| G-9 |
Laboratory Test for Rabies – MASTER, revised 09/2016 |
| G-14 |
Mosquito Surveillance Adult/Larval Specimen Submission Form – Sample, revised 01/2018 |
| G-19 |
Water Bacteriology Specimen Submission Form – Sample, revised 06/2018 |
| G-22 |
Environmental/Fluoride/Microbiological Specimen Submission – MASTER, revised 09/2016 |
| G-23 |
Food Sample Specimen Submission Form – Sample, revised 09/2016 |
| G-27 |
Biothreat Environmental Specimen Submission Form – Sample, revised 09/2016 |
| G-27A |
Emergency Preparedness Specimen Submission Form – Sample, revised 09/2016 |
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
|