Public Health Laboratory Documents and Forms

• PDF [536KB]
  Clinical Specimen Submission Requisition PDF [536KB]
  Form 1252
• PDF [337KB]
  Clinical Select Agent Rule-Out Submission Requisition PDF [337KB]
• PDF [152KB]
  SARS-CoV-2 (COVID-19) Testing Requisition and Shipping Guidelines PDF [152KB]
  Form 1198
• PDF [45KB]
  Submission Form for Mosquito Testing PDF [45KB]
  Form 1140
• PDF [79KB]
  CRE and CRPA Isolate Submission Requisition PDF [79KB]
  Form 1042
• PDF [141KB]
  Arbovirus Panel Request Form PDF [141KB]
  Form 8021
• PDF [83KB]
  HIV Antibody Request Form PDF [83KB]
  Form 364
• PDF [212KB]
  Influenza Testing Request Form PDF [212KB]
  Form 930
• PDF [139KB]
  Miscellaneous Laboratory Examination Request Form PDF [139KB]
  Form 402
• PDF [118KB]
  Mycobacteriology Culture Request Form PDF [118KB]
  Form 416
• PDF [57KB]
  TB EIA (QuantiFERON Gold In-Tube) Request Form PDF [57KB]
  Form 493
• PDF [154KB]
  Rabies Test Request Form PDF [154KB]
  Form 433

• PDF [190KB]
  Bottled Water or Ice Microbiology Request Form PDF [190KB]
  Form 411
• PDF [129KB]
  Drinking Water Fluoride Request Form PDF [129KB]
  Form 428
• PDF [151KB]
  Drinking Water Microbiology Request Form PDF [151KB]
  Form 425
• PDF [147KB]
  Drinking Water Microbiology Monitoring Sample Request Form PDF [147KB]
  Form 427

• PDF [383KB]
  First Responder Specimen Collection Guide PDF [383KB]
• PDF [1MB]
  First Responder/HAZMAT Field Testing for Environmental Samples PDF [1MB]
  Form 397
• PDF [98KB]
  MPHL Clinical Sample Submission Guidelines for Bioterrorism Agents PDF [98KB]
  June 2013
• PDF [109KB]
  MPHL Clinical Sample Submission Guidelines for Chemical Terrorism Agents PDF [109KB]
  June 2013
• PDF [138KB]
  Specimen Collection Flowchart for Chemical Exposure Event PDF [138KB]
  CDC
• PDF [87KB]
  Shipping Instructions for Specimens Collected from People Who May Have Been Exposed to Chemical Terrorism Agents PDF [87KB]
  CDC
• PDF [197KB]
  Shipping Blood Specimens to CDC after a Chemical Exposure Event PDF [197KB]
  CDC
• PDF [233KB]
  Shipping Urine Specimens to CDC after a Chemical Exposure Event PDF [233KB]
  CDC
• PDF [58KB]
  Chemical Terrorism Blood Specimen Collection and Shipping Manifest PDF [58KB]
  CDC
• PDF [41KB]
  Chemical Terrorism Urine Specimen Collection and Shipping Manifest PDF [41KB]
  CDC

• PDF [550KB]
  MPHL CLIA Certificate of Compliance PDF [550KB]

• PDF [2MB]
  Recognize. Rule-Out. Refer: Biothreat Agent Bench Cards for the Sentinel Clinical Laboratory PDF [2MB]
  September 2021
• PDF [16MB]
  Mississippi Clinical Laboratory Preparedness and Response Guide PDF [16MB]
  May 2018

• PDF [3MB]
  Laboratory Services Guide, Appendix C, Rabies Testing PDF [3MB]
  November 2016
• PDF [167KB]
  Zika Virus Test Requisition PDF [167KB]
  November 2016
• PDF [215KB]
  Patient Request for Release of Completed Laboratory Results PDF [215KB]
  Form AS0-1-0