Forms for the Infectious Disease Laboratory - Minnesota Dept. of Health

Forms for the Infectious Disease Laboratory

On this page:
Clinical Testing and Submission Form
Hospitalized Influenza Testing and Submission Form
Special Projects/Other Forms
CDC Select Agent Forms
Instructions, Helpful Hints, and Feedback

Clinical Testing and Submission Form

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Hospitalized Influenza Testing and Submission Form

Influenza, Hospitalized Patients Only – There is only one form required.

Instructions – There are the four (4) required questions on the bottom right corner of this form, and see Instructions for Clinical Testing and Submission Form (PDF) to complete the rest of the form.

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Special Projects/Other Forms

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CDC Forms

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Instructions, Helpful Hints and Feedback

Instructions

Certain fields are required by CLIA, so please read the instructions for each form carefully. Failure to provide required information delays testing while we contact the lab for the missing information. Please be sure to check the forms before sending samples to make sure that all necessary information is provided.

Helpful Hints

Since MDH-PHL serves the entire state of Minnesota and beyond it is important that the submitter information is complete. Please do not enter a facility acronym. If there are several clinics and/or hospitals with the same "system" name, please be sure to provide the city or other unique identifier to distinguish which facility is actually submitting the specimen and requesting the testing. Both of these tips will assist MDH-PHL in getting results to the proper submitter.

Feedback

Please submit comments or problems with MDH-PHL forms by email to health.mdhlab@state.mn.us. We would like to hear feedback so that we can make these forms as user friendly and functional as possible.

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Updated Tuesday, 17-Jan-2017 11:40:07 CST