Get Specimen Submission Form For Dept Of Health Lab Tn

Completing the Specimen Submission Form for the Tennessee Department of Health Lab is essential for proper specimen processing. This guide will walk you through the online filling process, ensuring you provide all necessary information clearly and accurately.

Follow the steps to successfully complete the form online.

1. Use the ‘Get Form’ button to access the Specimen Submission Form and open it in your preferred online editor.
2. Begin by filling out the demographics section for the patient. Include the last name, first name, middle initial, date of birth, reported age, and sex. Ensure all fields are accurately completed.
3. Provide the patient's street address, city, county, state, and zip code. Additionally, indicate the patient's ethnicity and race by checking the appropriate boxes.
4. In the lab report section, enter the submitting facility's name and the provider's name. Be sure to also fill in the facility's street address, city, county, state, and zip code. Include a phone number, fax number, and email address.
5. Document the details for specimen collection. For each specimen, include the date collected and the specimen source. If applicable, note any State Lab Accession numbers for internal use.
6. Complete the lab result section by checking the appropriate results for Hepatitis tests. Make sure to input the dates for each test result accurately.
7. Finally, provide the name of the person completing the form. Review all entries to ensure they are correct and complete.
8. Once you have filled out the form, you can save your changes. You may also download, print, or share the form as needed.

Take action now and complete the Specimen Submission Form online for a streamlined submission process.