MDL Form 448 – Fungus Culture for Identification
Electronic Submittal Form Instructions
NOTE: We are unable to process samples with inadequate information.
On page one, under “Select Test Requisition”, use the pull down menu to select Lab Form “Fungus Culture for Identification -448
”. 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 448, it is highly recommended that field 23 (Travel history), 40 (Submitter’s identification of Organisms), and 41 (Clinical History) be filled in with available information. For MDL form 448, it is REQUIRED that the following fields be filled in:
2.1. Field 30 (Submitter’s Phone number).
2.2. Field 31 (Submitter’s Fax number).
3. Follow the instructions below to provide additional information on page 2 “Fungus Culture for Identification-448 - Submitter's Laboratory Findings”:
3.1. Check box to indicate if antifungal agents were used at the time of specimen collection. If yes, list the agents.
3.2. Check box to indicate if the culture made from the original sample was pure or mixed. If mixed list the other organisms present.
3.3. Record colony count if applicable.
3.4. Record number of times organism was isolated from patient.
3.5. Check box to indicate if the organism was seen by stained smears made directly from clinical material.
3.6. Record the medium on which primary growth was obtained
3.7. Record the medium on which organism is being submitted and include the date inoculated incubation temperature and atmosphere.
3.8. Indicate the results of your laboratory examination of the pure culture isolate:
3.8.1. Record the growth rate at different temperatures and pigmentation of organisms on the medium of submission.
3.8.2. Record the colony morphology and microscopic characteristics.
3.8.3. Record the critical biochemical test results if applicable
3.8.4. Record major tests performed for identification and results in “Other test or Comment” field.
4. Print the completed Lab Form 448 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.
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. Do not submit fungal isolates on plates.
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 448 and all attachments between the inner and outer shipping containers.
6.8. If you have any questions regarding sample submission, call the MDL for guidance – 510-412-3700.