Laboratory Testing, Supplies & Reporting
Laboratory Test Request Forms
Laboratory Test Request forms are submitted for immunological evidence of infection from blood and CSF specimens and for isolation and/or identification of bacteria, fungi, parasites, or viruses.
- Fill in patient information in upper middle section: Last name, First name, and/or patient ID number, sex, and date of birth. Fill in billing information and diagnosis codes, if appropriate. Always verify that the name on the requisition and the name on the specimen are in agreement.
- Fill in the date and time specimen was collected in upper right section. If specimen is “other,” specify source on the blank line.
- Fill in your submitter code or facility name and address in the upper left section. Fill in the NPI# for providers outside the Public Health Department. Submitter numbers can be obtained by calling the Public Health Laboratory if you do not already have one.
- Mark the box for the test requested in the lower portion of the form. Mark the box for the specimen source. If the test or specimen source requested is not listed, write description in Submitter’s Comments section.
Most routine supplies needed to submit specimens to the Public Health Laboratory are provided free of charge. A laboratory supplies request form is available upon request for your orders. All orders may be mailed, faxed to (909) 986-3590, or delivered to the public health laboratory for delivery that week.
Laboratory test results are faxed as a single 8 ½ x 11-inch report. The report form includes comprehensive patient information as well as test results. Requests for copies of final reports must be submitted to the lab office staff by fax. Anyone who requires additional information on patient test results should contact the laboratory.