Forms for the Infectious Disease Laboratory
On this page:
Submission and Testing Forms
Antibiotic Resistance (AR) Laboratory Network
Special Projects/Other Forms
CDC Select Agent Forms
Instructions, Helpful Hints, and Feedback
Submission and Testing Forms
All forms are printable and fillable and optomized for Internet Explorer, Chrome, or Adobe. Forms will be updated often to add functionality, please bookmark this page to use most current version.
- General Infectious Disease Laboratory Submission Form (PDF)
- General Submission Form Guidance (PDF)
- Hospitalized Influenza Submission Form Project 1492 (PDF)
- Influenza Form Guidance (PDF)
- Non-Hospitalized Influenza Submission Form Project 493 (PDF)
- Influenza Form Guidance (PDF)
- COVID-19 Submission Form Project 2618 (PDF)
- COVID-19 Submission Form Guidance (PDF)
Antibiotic Resistance (AR) Laboratory Network
Sampling and Handling Guidance
- Candida auris Sampling and Handling Guidance (PDF)
- Carbapenem Resistant Organism (CRO) Sampling and Handling Guidance (PDF)
- MDH AR Laboratory Supply Form (Order Supplies, Boxes, Kits from MDH)
Supplies
Contact arlnmn@state.mn.us for questions, specimen handling, or free-of-charge shipping information.
Other MDH Forms
CDC Forms
- CDC Specimen Submission Form with Instructions
- CDC National Select Agent Registry Forms Home
- APHIS/CDC Form 4 – Report of Identification of a Select Agent or Toxin in a Clinical or Diagnostic Laboratory
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.