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MDL Form 446 - Bacterial Culture for Identification (exclude Mycobacteria) “Rule out for Select agents”

Electronic Submittal Form Instructions

Use Lab Form 446 - Bacterial Culture for Identification (exclude Mycobacteria) to submit culture isolates that cannot be ruled out for Bacillus anthracis, Burkholderia mallei or pseudomallei, Brucella species, Francisella tularensis and Yersinia pestis. 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 “Select Test Requisition”, use the pull-down menu to select Lab Form “Bacterial Culture for Identification (excluding Mycobacteria)-446”. Provide all necessary information on page 1. For directions on how to fill out the fields on page 1, please refer to the “General Specimen Submission Page 1 Instructions” page.

2. For MDL form 446 it is REQUIRED that the following fields be filled in:

2.1. Field 39 (Test(s) Requested).
2.2. Field 40 (Submitter’s identification of Organisms).
2.3. Field 41 (Clinical History).

3. Follow the instructions below to provide additional information on page 2 “Bacterial Culture for Identification-446 – Submitter’s 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. Record number of times the organism was submitted and isolated from patient.
3.3. Record the medium on which the primary growth was obtained.
3.4. Record the medium which the organism is being submitted and include the date inoculated, incubation temperature, atmosphere, and time.
3.5. Record the cellular morphology and gram stain.
3.6. Use the pull-down menu to record sentinel clinical laboratory biochemical test results as described by the APHL, CDC and ASM.
3.7. Record other tests or comments in the “Other Test or Comments Field”.

4. Print the completed Lab Form 446 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 “Infectious substance, Category A” and/or “Biological substance, Category B”.

6. Additional considerations when submitting samples:
6.1. Culture isolate should be pure.
6.2. Use a tubed solid agar medium that supports good growth of the organisms. Do not submit cultures on plated agar media.
6.3. Label sample tube with at least two identifiers (i.e. the patient’s 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 446 and all attachments between the inner and outer shipping containers.
6.6. Follow all other submission guidelines as described in the “General Specimen Submission Instructions” 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 – 510-412-3700.
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