Public Health Laboratory Documents and Forms
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
Clinical Services Specimen Submission Forms
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Clinical Specimen Submission Requisition
Form 1252
- Clinical Select Agent Rule-Out Submission Requisition
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SARS-CoV-2 (COVID-19) Testing Requisition and Shipping Guidelines
Form 1198
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Submission Form for Mosquito Testing
Form 1140
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CRE and CRPA Isolate Submission Requisition
Form 1042
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Arbovirus Panel Request Form
Form 8021
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HIV Antibody Request Form
Form 364
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Influenza Testing Request Form
Form 930
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Miscellaneous Laboratory Examination Request Form
Form 402
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Mycobacteriology Culture Request Form
Form 416
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TB EIA (QuantiFERON Gold In-Tube) Request Form
Form 493
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Rabies Test Request Form
Form 433
Environmental Services Sample Submission Forms
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Bottled Water or Ice Microbiology Request Form
Form 411
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Drinking Water Fluoride Request Form
Form 428
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Drinking Water Microbiology Request Form
Form 425
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Drinking Water Microbiology Monitoring Sample Request Form
Form 427
Terrorism Sample Submission
- First Responder Specimen Collection Guide
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First Responder/HAZMAT Field Testing for Environmental Samples
Form 397
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MPHL Clinical Sample Submission Guidelines for Bioterrorism Agents
June 2013
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MPHL Clinical Sample Submission Guidelines for Chemical Terrorism Agents
June 2013
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Specimen Collection Flowchart for Chemical Exposure Event
CDC
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Shipping Instructions for Specimens Collected from People Who May Have Been Exposed to Chemical Terrorism Agents
CDC
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Shipping Blood Specimens to CDC after a Chemical Exposure Event
CDC
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Shipping Urine Specimens to CDC after a Chemical Exposure Event
CDC
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Chemical Terrorism Blood Specimen Collection and Shipping Manifest
CDC
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Chemical Terrorism Urine Specimen Collection and Shipping Manifest
CDC
CLIA Certificate
- MPHL CLIA Certificate Extension Through April 30, 2023
- MPHL CLIA Certificate Extension Through March 31, 2023
- MPHL CLIA Certificate Extension Through February 28, 2023
- MPHL CLIA Certificate Extension Through January 31, 2023
- MPHL CLIA Certificate Extension Through November 30, 2022
- MPHL CLIA Certificate Extension Through October 31, 2022
- MPHL CLIA Certificate Extension Through September 31, 2022
- MPHL CLIA Certificate Extension Through August 31, 2022
- MPHL CLIA Certificate Extension Through July 31, 2022
- MPHL CLIA Certificate Extension Through June 31, 2022
- MPHL CLIA Certificate Extension Through May 31, 2022
- MPHL CLIA Certificate Extension Through April 31, 2022
Bioterrorism Response
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Recognize. Rule-Out. Refer: Biothreat Agent Bench Cards for the Sentinel Clinical Laboratory
September 2021
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Mississippi Clinical Laboratory Preparedness and Response Guide
May 2018
Other
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Laboratory Services Guide, Appendix C, Rabies Testing
November 2016
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Zika Virus Test Requisition
November 2016
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Patient Request for Release of Completed Laboratory Results
Form AS0-1-0
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Mississippi State Department of Health • 570 East Woodrow Wilson Dr • Jackson, MS 39216 • 866-HLTHY4U • Contact and information
