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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

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

G-399

Order Form for Child Health Laboratory Supplies

G-6D

Order Form for Newborn Screening Supplies  

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
G-6G Order Form for Courier Supplies

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.

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 6/2015 

South Texas Laboratory

F-14 Order Form for General Laboratory Supplies MASTER, revised 7/2014  
F40-A Chemistry Specimen Submission Form Sample, revised 9/2015
F40-B Microbiology Specimen Submission Form Sample, revised 9/2015
F40-C Biothreat Specimen Submission Form MASTER, revised 7/2014 
F40-D Emergency Preparedness Specimen Submission Form MASTER, revised 9/2015
G-1B
Biochemistry and Genetics Specimen Submission Form Sample, revised 9/2014; Instructions, revised 3/2015 
G-THSTEPS
Texas Health Steps Specimen Submission Form Sample, revised 9/2013 
G-2A
Serology Specimen Submission Form Sample, revised 9/2015
G-2B
Bacteriology and Parasitology Specimen Submission Form Sample, revised 9/2015
G-2V
Virology Specimen Submission Form Sample, revised 9/2015
G-MYCO Mycobacteriology / Mycology Specimen Submission Form Sample, revised 9/2015

G-9

Laboratory Test for Rabies MASTER, revised 9/2015

G-14

Mosquito Surveillance Adult / Larval Specimen Submission Form Sample, revised 9/2013 
G-19 Water Bacteriology Specimen Submission Form Sample, revised 9/2013 
G-22 Environmental / flouride / microbiological Specimen Submission MASTER, revised 9/2015
G-23 Food Sample Specimen Submission Form Sample, revised 9/2015
G-26 Uniform Analysis for TDCJ & TJJD Specimen Submission Form MASTER, revised 5/2014 
G-27 Biothreat Environmental Specimen Submission Form Sample, revised 4/2013 
G-27A Emergency Preparedness Specimen Submission Form Sample, revised 9/2014 


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 August 31, 2015