MDL Form 443 ā Mycobacteriology-Culture for Identification
Electronic Submittal Form Instructions
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
āMycobacteriology-Culture Identification-443ā. Provide all necessary information on page
2. For MDL form 443, it is REQUIRED that the following fields be filled in:
2.1. Field 40 (Submitterās identification of Organisms).
2.2. Field 41 (Clinical History).
3. Follow the instructions below to provide additional information on page 2 āMycobacteriology-Culture Identification-443ā Submitterās Laboratory Findings":
3.1. Check box to indicate if the culture made from the original sample was pure or mixed. If mixed, list the other organisms present.
3.2. Check box of colony counts on the primary isolation media.
3.3. Check box on how frequent organism has been recovered.
3.4. Check box if M. tuberculosis complex was recovered from patient prior to current specimen.
3.5. Record the medium which the organism is being submitted and include the date inoculated incubation temperature, atmosphere and time.
3.6. Results of submitters Laboratory examination:
3.6.1. Record the colony morphology.
3.6.2. Check boxes to record the laboratory results.
3.7. Record laboratory results of other procedures.
3.8. Record other test in āOther test or Commentā field.
4. Print the completed Lab Form 443 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. Culture isolate should be pure. MGIT broths are also acceptable.
6.2. Use a tubed solid medium. Do not submit cultures on plated agar media.
6.3. Label sample tube with at least two identifiers (i.e. the patientās name, submitter lab number, date of birth) and the date inoculated.
6.4. For safety, all submitted culture tubes must have a tightened screw cap secured in place using tape.
6.5. Before shipment, insert the completed Lab Form 443 and all attachments between the inner and outer shipping containers.
6.6. Follow all other submission guidelines as described in the āGeneral Specimen Submission Instructionsā and guides located on the MDL Services and Test Catalog website
.
6.7. If you have any questions regarding sample submission, call the MDL for guidance ā 510-412-3700.