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Microbial diseases laboratory

MDL Form 443 – Mycobacteriology-Culture for Identification 

Electronic Submittal Form Instructions

Use Lab Form 443 - Mycobacteriology-Culture Identification to submit culture isolates. 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
Mycobacteriology-Culture Identification-443”. Provide all necessary information on page
1. For directions on how to fill out the fields on page 1, please refer to “General Specimen Submission Page 1 Instructions” page.

2. For MDL form 443, it is REQUIRED that the following fields be filled in:
2.1. Field 40 (Submitter’s identification of Organisms).
2.2. Field 41 (Clinical History).

3. Follow the instructions below to provide additional information on page 2 “Mycobacteriology-Culture Identification-443– 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. 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 “Other test or Comment” 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 “Infectious substance, Category A” and/or “Biological substance, Category B”.

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 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 443 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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