Welcome to the State of California 

 

VRDL Specimen Submittal Forms

NOTE:   Guidance for Shipping Measles Samples to VRDL available here. 

 

  • General   
  •      General Purpose Specimen Submittal Form (PDF)

     

  • Arbovirus
  •           

               Instructions for Completing VRDL Specimen Submittal Form for Zika Virus Testing for Symptomatic Patients (PDF)

                     - Use VRDL General Purpose Specimen Submittal Form (PDF)

               Instructions for Completing VRDL Specimen Submittal Form for Zika Virus Testing for Asymptomatic Pregnant Women (PDF)

                     - Use VRDL General Purpose Specimen Submittal Form (PDF)

               Instructions for Completing CDC DASH Form for Zika Virus Testing for Asymptomatic Pregnant Women (PDF)

                     - Use CDC Specimen Submittal Form 50.34          

               Instructions for Completing CDC DASH Form for Zika Virus Testing for Symptomatic Patients (PDF)

                     - Use CDC Specimen Submittal Form 50.34  

     

  • Encephalitis
  •           Neurologic Surveillance Testing Case History Form (PDF)

              Neurologic Surveillance Testing - Instructions for Sending Specimens (PDF)

              Neurologic Surveillance Testing - Specimen Submittal Form (PDF)

     

  • Enterovirus
  •            Outpatient HFMD Case Report (Word)

               Hospitalized Enterovirus Case Report Form (Word)

               Enterovirus D68 (EV-D68) Surveillance Submittal Form (PDF)

               Enhanced Enterovirus Surveillance Submittal Form (Word)

     

  • Gastroenteritis
  •            Norovirus Labortatory Network (NLN) Guidance for 2015-2016 Norovirus Season  (Word)

               Confirmed Norovirus Outbreak Submittal Form for Strain Typing   (Word)

               Unexplained Gastroenteritis Outbreak Specimen Submittal Form  (Word)

     

  • Rabies: Animal-- (For suspect human rabies, consult Neurologic Surveillance Testing - Instructions for Sending Specimens)
  •            Rabies virus Strain Typing and Bat ID Specimen Submittal Form (PDF)

               Rabies virus – Specimen Submittal Form for Suspected Rabid Animals (PDF)  

     

  • Respiratory
  •            Isolate for Identification or Strain Typing Specimen Submittal Form (Non- influenza) (PDF)

               Influenza Reference Examination Submittal Form (PDF) (Use for isolates) 

               Influenza and  Respiratory Individual Specimen Submittal Form (Use for original clinical specimens) (PDF)

               Hantavirus Case History and Specimen Submittal Form (PDF)

               Pediatric Influenza Specimen Submittal Form (PDF)

               Respiratory Fatal Case Submittal Form (PDF)  (Word)

               Respiratory Outbreak – Group Specimen Submittal Form (PDF)

               Respiratory Outbreak from a Long Term Care Facility – Group Submittal Form (PDF)

               Severe Illness Laboratory Surveillance (SILS) Specimen Submittal Form (Word)

               Non-Influenza Respiratory Disease (NIRD) Surveillance Submittal Form (PDF)

     

  •  Retrovirus      

  •            HIV Submittal Form (Antibody & Antigen Testing) (PDF)

               HTLV Antibody Tests Form (PDF)

     

  • Vaccine Preventable-- (For measles, rubella or varicella, use General Purpose Specimen Submittal Form)
  •            Mumps Virus Specimen Collection Form (PDF) 

               General Purpose Specimen Submittal Form (PDF)

               Vaccine Preventable Reference Examination Submittal Form (for isolates of lab confirmed specimens) (PDF) 

                      - For original specimens that have not been tested, use the General Purpose Specimen Submittal Form

     Guidance for Shipping Measles Samples to VRDL (PDF) 

     

     

     
     
    Last modified on: 5/26/2016 4:46 PM