OLS - Forms

LABORATORY FORMS

Specimen Submission Forms

BIOTERRORISM RESPONSE

Clinical Specimen Submission Form for Suspected Bioterrorism Agents
Environmental Specimen Submission Form
Threat Preparedness Chain of Custody Form

DIAGNOSTIC IMMUNOLOGY

Diagnostic Immunology Specimen Submission Form
Lyme Disease Specimen Submission Form

ENVIRONMENTAL CHEMISTRY

Analyte Testing List
Environmental Chemistry Sample ID Tag
Water Fluoridation Report

MICROBIOLOGY

Arbovirus Animal Specimen Submission Form
Arbovirus Human Specimen Submission Form
Food Specimen Submission Form
Influenza Specimen Submission Form
Microbiology Specimen Submission Form
Rabies Specimen Submission Form

SUPPORT SERVICES FORMS AND SPECIMEN KIT REQUEST FORMS

Arbovirus Specimen Kit Request Form
Arbovirus Specimen Collection Instructions
Chain of Custody
CLIA Database Change Form
CLIA Application (116)
CLIA WV Form - Annual Test Volume Log
Dead Bird Oral Swab Collection Procedures
Diagnostic Immunology Supply Order Form
Diagnostic Immunology Supply Order Instructions
Fluoride Bottle Request Form
Influenza Specimen Kit Request Form
Influenza Test Report Interpretation
Laboratory Personnel Qualification Appraisal and Application for Licensure
Micro Speciment Kit Requisition Form
Newborn Specimen Collection Instructions
Newborn Specimen Collecton Kit Order Form
Newborn Specimen Collection Training Video Order Form
Pertussis Collection Kit Instructions
Shippers Declaration For Dangerous Goods
Shippers Declaration For Dangerous Goods - TB
Stool Collection Instructions
Water Bottle Request Form

TRAINING

See the Training Section for specific course information and registration forms.

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167 Eleventh Avenue
South Charleston
WV 25303
Ph. 304-558-3530
Fx. 304-558-2006