X (circle): Onset DOB: M F Date: Disease suspected or test requested: Route to: [ ] SERO [ ] ISOL [ ] FA [ ] RAB [ ] EM This section for Virus Laboratory use only. Date received by VRDL and State Accession Number Specimen type and/or specimen source Date Collected Specimen type and/or specimen source Date Collected 1 st 1 st [ ] BE [ ] LC [ ] _____ [ ] _____ [ ] _____ 2 2 [ ] _____ [ ] E IgM Viral and Rickettsial Disease Laboratory [ ] E PCR California Department of Public Health [ ] .
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How to use or fill out the CA VRDL Specimen Submittal Form online
Filling out the CA VRDL Specimen Submittal Form online is a straightforward process that ensures your specimen is submitted correctly for testing. This guide provides clear, step-by-step instructions to help you complete each section of the form with confidence.
Follow the steps to successfully complete the form online.
- Press the ‘Get Form’ button to access the specimen submittal form and open it in the editor.
- Begin by entering the patient’s mailing address, including the Zip code. Ensure that all information is accurate.
- Next, fill in the patient’s last name and first name, followed by their age or sex. Circle 'M' for male or 'F' for female, and include the patient’s date of birth.
- Indicate the disease suspected or the specific test requested in the designated section.
- In the route section, select the appropriate option(s) by marking the checkboxes next to 'SERO,' 'ISOL,' 'FA,' 'RAB,' or 'EM' as applicable.
- Provide the specimen type and/or specimen source and the date collected, ensuring to include multiple specimens if necessary.
- For the clinical information section, check the relevant boxes or fill in details to describe the patient's condition as needed.
- Complete the clinical findings section by checking all relevant symptoms or adding notes where necessary.
- If applicable, state whether the patient is immunocompromised by checking 'Yes' or 'No.'
- Finally, enter the submitting physician’s name and contact number, as well as the submitting facility’s name and fax number.
- Once all sections are completed, you can save changes, download, print, or share the form as required.
Take the first step in completing your forms online to ensure accurate specimen submission.
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