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VRDL Specimen Submittal Forms


  • General   
  • ***Please note that the VRDL will no longer accept handwritten General Purpose Specimen Submittal forms beginning October 1, 2016.

    Forms can be filled out and saved electronically using the free Adobe Acrobat Reader download available at: https://get.adobe.com/reader/.

    General Purpose Specimen Submittal Form (PDF)


  • Arbovirus
  •            VRDL General Purpose Specimen Submittal Form (PDF)

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


  • 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 2016-2017 Norovirus Season (PDF)

               Confirmed Norovirus Outbreak Submittal Form for Strain Typing   (Word)

               Unexplained Gastroenteritis Outbreak Specimen Submittal Form  (Word)


  • Rabies: Animal
  •            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      

  •            General Purpose Specimen Submittal Form (PDF)


  • Vaccine Preventable
  •            General Purpose Specimen Submittal Form (PDF)

     Guidance for Shipping Measles Samples to VRDL (PDF) 



    Last modified on: 1/9/2017 10:20 AM