Public Health Laboratory Documents and Forms

Español / Tiếng Việt / English

This page has been automatically translated from English. MSDH has not reviewed this translation and is not responsible for any inaccuracies.

Last reviewed on Nov 30, 2022

found an error? email page print

Clinical Services Specimen Submission 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

Environmental Services Sample Submission Forms

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

Terrorism Sample Submission

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

CLIA Certificate

PDF [565KB]
MPHL CLIA Certificate of Compliance PDF [565KB]

Bioterrorism Response

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

Other

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

To view/print PDF documentation you will need Adobe Reader

Mississippi State Department of Health • 570 East Woodrow Wilson Dr • Jackson, MS 39216 • 866‑HLTHY4U • Contact and information

Accredited by the national Public Health Accreditation Board