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    Contact Us

    Laboratory Services Section
    MC 1947
    PO Box 149347 Austin, TX 78714-9347
    1100 W. 49th Street
    Austin, TX 78756-3199

    Phone: (512) 776-7318
    Fax: (512) 776-7294

    Phone Us Toll Free at:
    (888) 963-7111, ext. 7318

    Mailing/Shipping Info

    Email the Laboratory

Laboratory Testing Services Manual - Forms and Laboratory Fee Schedule

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- Introduction | Changes to Lab Testing Services Manual | Contact Information | Local Health Department Labs | Specimen Collection and Submission | Specimen Shipping, Mailing | Specimen Receiving, Lab Hours | Lab Tests | Forms, Fee Schedule | Technical Definitions -

Forms

Fees


Order Forms for Laboratory Mailing Containers and Supplies

Phone (512) 776-7661 
Fax (512) 776-7672

Some of these forms are in PDF format. See the file viewing information. Supplies are provided only for testing performed at the DSHS Laboratory.

Order Forms for Laboratory Mailing Containers and Supplies

Form #

Name

G-6A

Order Form for General Supplies (PDF 84kb)

G-6C Order Form for Gonorrhea/Chlamydia (GC/CT) Laboratory Supplies (PDF 85kb)

G-399

Order Form for Child Health Laboratory Supplies (PDF 91kb)

G-6D

Order Form for Newborn Screening Supplies (PDF 35kb) 

G-6E

Order Form for PKU Monitoring Supplies
Medical Providers
: To order supplies for PKU Monitoring, contact DSHS Container Preparation Group at 1-888-963-7111 ext. 7661.
Patients: Please contact your metabolic physician or metabolic clinic to get additional PKU Monitoring collection supplies.

G-6F

Order Form for TB Supplies (PDF 82kb)
G-6G Order Form for Courier Supplies (PDF 108kb)

Test Request Form Samples and G-9 Form - Laboratory Services

Phone No. (512) 776-7578
FAX No. (512) 776-7533

Note: Unless otherwise noted, these are sample forms only. To receive specimen submission forms with your submitter identification, please request forms by email or by phone. If you do not yet have a submitter identification number, please complete and submit the Submitter Identification (ID) Number Request Form (PDF 27kb).

When printing out the sample forms below, you may notice that some of the section headings in white type do not print correctly. In that case, choose File > Print from your browser menu, then in the Print dialog box, check the option that says "Print as image." This option is located directly underneath the "Properties" button. Then click the "Ok" button. The sample form should then print normally.

Test Request Form Samples and Master Forms

Form #

Name
  Program Descriptions for Laboratory Forms
  Submitter Identification (ID) Number Request Form, revised 9/2013 (PDF 30kb)

South Texas Laboratory

F-14
Order Form for General Laboratory Supplies MASTER, revised 7/2014 (PDF 85kb) 
F40-A
Chemistry Specimen Submission Form Sample, revised 9/2013 (PDF 138kb) 
F40-B
Microbiology Specimen Submission Form Sample, revised 9/2013 (PDF 138kb) 
F40-C
Biothreat Specimen Submission Form MASTER, revised 7/2014 (PDF 111kb)
F40-D
Emergency Preparedness Specimen Submission Form MASTER, revised 9/2014 (PDF 67kb)
G-1B
Biochemistry and Genetics Specimen Submission Form Sample, revised 9/2014 (PDF 696kb)
G-THSTEPS
Texas Health Steps Specimen Submission Form Sample, revised 9/2013 (PDF 167kb)
G-2A
Serology Specimen Submission Form Sample, revised 9/2014 (PDF 648kb)
G-2B
Bacteriology and Parasitology Specimen Submission Form Sample, revised 9/2014 (PDF 646kb)
G-2V
Virology Specimen Submission Form Sample, revised 9/2014 (PDF 633kb)
G-MYCO Mycobacteriology / Mycology Specimen Submission Form Sample, revised 9/2013 (PDF 101kb)

G-9

Laboratory Test for Rabies MASTER, revised 9/2013 (PDF 60kb)

G-14

Mosquito Surveillance Adult / Larval Specimen Submission Form Sample, revised 9/2013 (PDF 69kb)
G-19 Water Bacteriology Specimen Submission Form Sample, revised 9/2013 (PDF 30kb)
G-22 Environmental / flouride / microbiological Specimen Submission MASTER, revised 9/2013 (PDF 32kb)
G-23 Food Sample Specimen Submission Form Sample, revised 9/2013 (PDF 61kb)
G-26 Uniform Analysis for TDCJ & TJJD Specimen Submission Form MASTER, revised 5/2014 (PDF 23kb)
G-27 Biothreat Environmental Specimen Submission Form Sample, revised 4/2013 (PDF 33kb)
G-27A Emergency Preparedness Specimen Submission Form Sample, revised 9/2014 (PDF 566kb)


Obtaining Specimen Submission Forms by email

Email request to: Laboratory Forms. Please provide required information below when requesting forms by email.

Required Information

G-2A or G-2B Microbiology Submission Forms 
The following information is needed to request a G-2A and or G-2B submission form:
  • Submitter Number
  • Submitter National Provider Identification Number (NPI)
  • Provider Name
  • Mailing Address
  • City, State, Zip
  • Phone Number
  • Fax Number
  • Contact person name
  • Physician Name
  • Physician's NPI Number
  • Physician's UPIN Number
  • Email address

G-1B Specimen Submission Form and G-THSTEPS Specimen Submission Form 
The following information is needed to request a G-1B or G-THSTEPS submission form:

  • Texas Provider Identifier Number (TPI)
  • National Provider Identification Number (NPI)
  • Provider Name · Mailing Address
  • City, State, Zip
  • Phone Number
  • Fax Number
  • Contact person name
  • Physician Name
  • Physician's NPI Number
  • Physician's UPIN Number
  • Email address

 

Last updated October 07, 2014