PHL Test Details
Oklahoma Department of Health, Public Health Laboratory
081720
COVID-19 TESTING REQUIRED PATIENT DEMOGRAPHIC INFORMATION
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Patient Information
Patient ID:
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(check all that apply)
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Ethnicity:
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Submitter Information
Clinician/Practitioner:
Clinician/Practitioner: Last: *
Clinician/Practitioner: First: *
Clinician/Practitioner: Middle:
Practitioner NPI:
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Address: *
City: *
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Oklahoma
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
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Family Planning
STD
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Dysplasia
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Clinical Information
Clinical Onset:
Antibiotics:
Clinical Diagnosis:
Specimen Information
Collection Date:
Time:
Collection By:
Outbreak:
Comment:
Virology
Bacteriology
Mycobacteriology
Parasitology
Virology
Test Request
Specimen Type/Source
Details
Hepatitis B surface antigen (HBsAg)
Serum
2 mL in spun serum separator tube; approved submitters only
HIV-1/2 antigen/antibodies
Serum
2 mL in spun serum separator tube; approved submitters only
Human papillomavirus, high risk
Residual ThinPrep
1 mL
Influenza virus A and B
Swab, nasopharyngeal
1 or 2 synthetic swabs in viral transport medium; preferred specimen
Swab, nasal
1 or 2 synthetic swabs in viral transport medium
Swab, throat
1 or 2 synthetic swabs in viral transport medium
Other (specify source)
Contact laboratory prior to submission
Respiratory Pathogen Panel
Swab, nasopharyngeal
1 or 2 synthetic swabs in viral transport medium; or other appropriate commercial medium (UTM, M4, and M4RT)
Rubella antibodies
Serum
1 mL in spun serum separator tube; female county heath department patients only
2019 Novel Coronavirus (2019-nCoV)
Select Source
Swab, nasopharyngeal
Swab, mid-turbinate
Swab, nasal
Swab, oropharyngeal
Sputum
Bronchoalveolar lavage
Other-specify below
Swabs: synthetic swabs in viral transport medium; or other appropriate commercial medium (UTM, M4, M4RT, and saline)
Fluids (i.e., sputum, BAL, etc.): 2 mL in sterile container
West Nile virus/St. Louis encephalitis virus, IgM Antibodies
Serum
1 mL in spun serum separator tube
CSF
1 mL in sterile container (
must
be accompanied by serum)
Zika virus, Dengue virus, Chikungunya virus, PCR
Requires pre-approval by OSDH Acute Disease Service
Serum
2 mL in spun serum separator tube
CSF
1 mL in sterile container (
must
be accompanied by serum)
Urine
1 mL in sterile container (
must
be accompanied by serum)
Amniotic fluid
1 mL in sterile container (
must
be accompanied by serum)
Bacteriology
Test Request
Specimen Type/Source
Details
Bacterial isolate: identification/serotyping/confirmation
Aerobic isolate
Anaerobic isolate
CRE isolate
CRPA isolate
H. influenzae isolate
N. meningitidis
Aeromonas/Vibrio isolate
Campy isolate
E. coli isolate
Salmonella isolate
Shigella isolate
Yersinia species isolate (not Y. pestis)
Specify source
Abscess
Aspirate
Bronchoalveolar lavage
Blood
CSF
Lung
Pleural fluid
Serum
Sputum
Stool
Urine
Wound
Other-specify below
Plate or slant with visible growth, pure isolate only
Note: If organism suspected is not listed, write name in Comment field above
Bacteria, non-enteric: isolation and identification
Specify source
Blood culture
CSF
Lung
Stool
Swab
Tissue
Wound
Other-specify below
Medical examiner or prior authorization only
Enteric pathogens: isolation and identification
Stool, Cary Blair
2 g solid or 5-10 mL liquid feces in Cary Blair Transport Media
Stool, GN broth (STEC only)
Visible growth in GN Broth
Chlamydia/Gonorrhea
Urine
Collect first 20-60 mL of 1st morning void then transfer to UPT tube
Vaginal swab
Use only BD vaginal specimen transport device (purple-shaft swab + transport tube)
Group B streptococcus
Swab, vaginal and anal
Swab in LIM broth (combined vaginal/anal swab preferred)
Swab, vaginal
Swab in LIM broth
Swab, anal
Swab in LIM broth
Bordetella: PCR
Swab, nasopharyngeal
1 or 2 synthetic swabs in Reagan Lowe Transport Media
Cultured isolate (specify source)
Visible growth, pure isolate
Syphilis, serology (Reverse Algorithm)
Serum
2 mL in spun serum separator tube
Bacteria, environmental
Environmental (specify source)
Prior authorization required
Mycobacteriology
Test Request
Specimen Type/Source
Details
Fungal isolate identification
Mold and Yeast
Filamentous aerobic actinomycete
Histoplasma capsulatum (suspect)
Blastomyces dermititidis (suspect)
Coccidioides immitis (suspect)
Specify source
Abscess
Bronchoalveolar lavage
Blood
Bronchial wash
Finger
Foot
Lung Tissue
Lymph Node
Nail
Sinus
Skin
Sputum
Tissue
Wound
Other-specify below
Plate or slant with visible growth
Mycobacteria (acid-fast bacilli): smear and culture with reflex to identification
Specify source
Abscess
Bronchoalveolar lavage
Biopsy
Blood
Bronchial brush
Bronchial wash
CSF
Lung Tissue
Lymph Node
Pericardial fluid
Pleural fluid
Sinus
Sputum, expectorated
Sputum, induced
Tissue
Tracheal aspirate
Urine
Wound
Other-specify below
Blood: 5-10 mL ACD or heparin
Fluids: 5-10 mL
Sterile Fluids: 2-5 mL
Tissue: 1 g
Mycobacteria, isolate identification
Specify source
Abscess
Bronchoalveolar lavage
Blood
Bronchial brush
Bronchial wash
Lung Tissue
Lymph Node
Sinus
Sputum, expectorated
Sputum, induced
Tissue
Tracheal aspirate
Wound
Other-specify below
Liquid: >3 mL, pure isolate; Solid: visible growth, pure isolate
M. tuberculosis complex: PCR
Select source
Bronchoalveolar lavage
Bronchial brush
Bronchial wash
Sputum, expectorated
Sputum, induced
Tracheal aspirate
5-10 mL; includes AFB smear and culture per CDC guidelines
Parasitology
Test Request
Specimen Type/Source
Details
Parasites, blood
Blood, stained smears (Babesia, trypanosomes, filariae)
Giemsa or Wright-Giemsa-stained
thin
AND
thick
smears; at least one of each
Blood, stained smears and EDTA blood tube (Malaria)
Giemsa or Wright-Giemsa-stained
thin
AND
thick
smears; at least one of each; 2-6 mL EDTA blood