Forms

Diagnostic Immunology

Specimen Collection Kit Request Form

[collection kit request forms can be emailed to: dhhrolssupplyorder@wv.gov]

Test Request Submission Form (blood/urine)

Test Request Submission Form (Hepatitis only)

TB Clinic Test Request Submission Form

Instructions for TB Clinic Test Request Submission Form

Microbiology

General Microbiology Specimen Collection Kit Request Form

Influenza/Respiratory Pathogen Specimen Collection Kit Request Form

Rabies Sample Collection Kit Request Form

[collection kit request forms can be emailed to: dhhrolssupplyorder@wv.gov]

Stool Specimen Collection Instructions (Enterics)

Stool Specimen Collection Instructions (Parasitology)

Pinworm Specimen Collection Instructions

Pertussis Specimen Collection Instructions

Influenza Specimen Collection Instructions

AFB Specimen Collection Instructions

General Microbiology Specimen Test Request Submission Form

Rabies Test Request Submission Form

Food Sample Test Request Submission Form [prior approval required]

Equine Testing (through NVSL) - Sample Submission Form [prior approval required]

Newborn Screening

Collection Procedure Manual

Specimen Collection Instructions

Specimen Collection Kit Order Form

Specimen Collection Kit Order Form (birthing facility)

Specimen Collection Training Video Request Form

[collection kit request forms can be emailed to: dhhrolssupplyorder@wv.gov]

Environmental Chemistry

Algal Bloom Report Form

Bottle Request Form (Water Chemistry)

Sample Submission Form (Water Chemistry)

Sample Submission Form (Pediatric)

Sample Submission Form (Harmful Algae Bloom)

Environmental Microbiology

Water Sample Collection Bottle Request Form

Specimen Submission Form (not available electronically; call for copy)

Threat Preparedness

BT Clinical Specimen Test Request Submission Form

BT Environmental Sample Test Request Submission Form

CT Clinical Specimen Test Request Submission Form (pending)

CT Environmental Sample Test Request Submission Form (pending)

Other

Chain of Custody Record

Designation of Instrument/Device

Preliminary Testing for Intoxication Form

Secondary Testing for Intoxication Form

West Virginia Office
of Laboratory Services

167 11th Ave
South Charleston, WV 25303

Phone:
304-558-3530

Forms

Diagnostic Immunology

Microbiology

Newborn Screening

Environmental Chemistry

Environmental Microbiology

Threat Preparedness

Other

Designation of Instrument/Device

Documents