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Notify CDC About Specimens Being Shipped

Please help CDC track incoming specimens by completing the form below. Any information you provide will be handled according to the CDC Privacy Policy

IMPORTANT:

• Consultation with the state epidemiologist and state health laboratory is necessary before sending specimens to CDC.
• The appropriate specimen collection form MUST accompany any specimens shipped to CDC:
  • Human specimen collection form PDF (111 KB/6 pages)
  • Animal specimen collection form PDF (167 KB/3 pages)

Shipping Information Name of person shipping: Institution: E-mail address: Telephone: Alternate Telephone: Shipping Company: Tracking Number: CDC Number (if known): Date Shipped: Specimen Information HUMAN SPECIMENS: Number of specimens being shipped: Types of specimens being shipped (e.g., urine, stool, throat): ANIMAL SPECIMENS: Number of specimens being shipped: Types of specimens being shipped (e.g., urine, stool, throat): Other Notes (e.g., patient initials, sex, date of birth; please also note how specimens from different patients can be identified)

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Page last modified September 5, 2008

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