MDL Form 446 - Bacterial Culture for Identification (exclude Mycobacteria)
Electronic Submittal Form Instructions
NOTE: We are unable to process samples with inadequate information.
1. On page 1, 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
2. For MDL form 446, it is REQUIRED that the following additional 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).
2.4. For clinical or regional (non-public health) laboratories the following information is
REQUIRED to be filled in:
2.4.1. Field 12 (Patient Street Address).
2.4.2. Field 13 (City).
2.4.3. Field 15 (State).
2.4.4. Field 16 (Zip).
3. Follow the instructions below to provide additional information on page 2 “Bacterial Culture for Identification-446 – Submitter’s Laboratory Findings":
3.1. Check the 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 colony count if applicable (e.g. urine).
3.3. Record the number of times the organism was submitted and isolated from patient.
3.4. Record the medium on which the primary growth was obtained.
3.5. Record the medium on which the organism is being submitted and include the date inoculated incubation temperature, atmosphere, and time.
3.6. Record the cellular staining morphology.
3.7. Use the pull down menu to record the critical biochemical test results if applicable.
3.8. Use the pull down menu to record the Immunoassay. If the appropriate “Immunoassay” is not listed, select “Other” from the pull-down menu. Enter the method used and results in the box below.
3.9. Use the pull down menu to record the Identification Method. If the appropriate “Identification Method” is not listed in the dropdown menu, select “Other” from the pull-down menu. Enter the method used and results in the box below.
3.10. Record other test in “Other test or Comment” 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 organism. Do not submit cultures on plated agar media.
6.3. Label the 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. Do not submit Enterobacteriaceae on TSI slants. The preferred medium is without carbohydrates.
6.5. For safety, all submitted culture tubes must have a tightened screw cap secured in place using tape.
6.6. Before shipment, insert the completed Lab Form 446 and all attachments between the inner and outer shipping containers.
6.8. MDL Services and Test Catalog website.
6.9. If you have any questions regarding sample submission, call the MDL for guidance –