MDL Form 416 ā Parasitology
Electronic Submittal Form Instructions
Use
Lab Form 416 - Parasitology to submit specimens for PCR testing of
Plasmodium species, Entamoeba histolytica, Giardia lamblia, Cryptosporidium sp., Cyclospora cayetanensis or referrals to CDC. Use the following steps to enter information for the submission of
each specimen.
NOTE: We are unable to process samples with inadequate information.
1. On page one, under āSelect Test Requisitionā, use the pull-down menu to select Lab Form ā
Parasitology-416ā. Provide all necessary information on page 1. For directions on how to fill out the fields on page 1, please refer to the ā
General Specimen Submission Page 1 Instructionsā page.
2. For MDL form 416, it is REQUIRED that the following fields be filled in:
2.1. Field 23 (Travel History).
2.2. Field 39 (Test(s) Requested).
2.3. Field 40 (Submitterās identification of Organisms).
2.4. Field 41 (Clinical History, treatments received).
3. Follow the instructions below to provide additional information on page 2 āParasitology-416 - Additional Test Information":
3.1. Check box to indicate the test requested.
3.2. If referral to CDC, type in the test requested.
4. Print the completed Lab Form 416 front to back. The document is formatted for 2-sided printing.
5. Packaging and shipping: The submitter is responsible for making sure that all samples are packaged and shipped according to the current federal and state packaging and shipping regulations for āInfectious substance, Category Aā and/or āBiological substance, Category Bā.
6. Additional considerations when submitting samples:
6.1. Clinical specimens should be appropriately sealed to prevent leakage during transport.
6.2 Label sample tube with at least two identifiers (i.e. the patientās name, submitter lab number, date of birth) and the date inoculated.
6.3. For safety, all submitted sample tubes must have a tightened screw cap secured in place using tape.
6.4. Before shipment, insert the completed Lab Form 416 and all attachments between the inner and outer shipping containers.
6.6. If you have any questions regarding sample submission, call the MDL for guidance ā 510-412-3700.