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Laboratory Services Section Home

Manual Of Reference Services

- Introduction | Contact Information | Local Health Department Labs | Specimen Collection and Submission -

- Specimen Shipping, Mailing | Specimen Receiving, Lab Hours | Lab Tests | Forms, Fee Schedule -

Forms and Lab Fee Schedule

[Lab Fee Schedule]

Order forms for Lab mailing containers and supplies
Test Request Form Samples and G-9 Form - Laboratory Services
Obtaining Test Request Forms by email

Order forms for Lab mailing containers and supplies ^ Top

Phone No. (512) 458-7661
Fax No. (512) 458-7672

Some of these forms are in PDF format. See the file viewing information.

Form #	Name of the form
G-6A	CONTAINERS & FORMS, LABELS & KITS (pdf, 27k)
G-6B	TITLE V/SDI CONTAINER & ORDER FORM (pdf, 24k)
G-399	THSTEPS/CHILD HEALTH LABORATORY SUPPLIES FORM (pdf, 24k)
	NEWBORN SCREENING SUPPLIES ORDER FORM (pdf, 98k) Revised 1-26-07
	PKU MONITORING LAB SUPPLIES ORDER FORM (pdf, 71k)
	TB SUPPLIES ORDER FORM (pdf, 64k)
	GENPROBE COLLECTORS ORDER FORM (pdf, 73k)
G-19	WATER BACTERIOLOGY

Test Request Form Samples and G-9 Form - Laboratory Services ^ Top

Phone No. (512) 458-7578
FAX No. (512) 458-7533

Note: These are sample forms only, (except for the G-9). To receive submission forms with your submitter identification, please request forms by email or by phone.

When printing out the sample forms below, you may notice that some of the section headings in white type do not print correctly. In that case, choose File> Print from your browser menu, then in the Print dialog box, check the option that says "Print as image". This option is located directly underneath the "Properties" button. Then click the Ok button. Your form sample should then print normally.

Form #	Name of the form
	Program Descriptions for Lab Forms
F-40- 11036	South Texas Laboratory Specimen Submission Form (Sample pdf, 127k) (Instructions)
G-1B	Biochemistry and Genetics specimens (Sample pdf, 112k) (Instructions) Effective May 2006, a copy of the medicaid card is no longer required for laboratory specimen submission.
G-1B	en español: (Ejemplo pdf, 41k) (Instrucciones)
G-1C	Maternal Serum Prenatal Triple Screen specimens (Sample pdf, 39k) (Instructions)
G-1C	en español: (Ejemplo pdf, 33k) (Instrucciones)
G-2A	Serology and Virology specimens (Sample pdf, 112k) (Instructions)
G-2A	en español: (Ejemplo pdf, 40k) (Instrucciones)
G-2B	Bacteriology and Parasitology specimens (Sample pdf, 74k) (Instructions)
G-2B	en español: (Ejemplo pdf, 36k) (Instrucciones)
G-9	LABORATORY TEST FOR RABIES ( MASTER) (pdf, 15k)
G-14	MOSQUITO SURVEILLANCE ADULT/LARVAL (MASTER)
T-1	Newborn Screening Thyroid specimens (Sample pdf, 54k) (Instructions)

Obtaining Test Request Forms by email ^ Top

Email request to:
Please provide required information below when requesting forms by email.

Required Information

G-2A or G-2B Microbiology Submission Forms
The following information is needed to request a G-2A and or G-2B submission form:

Submitter Number
Submitter National Provider Identification Number (NPI)
Provider Name
Mailing Address
City, State, Zip
Phone Number
Fax Number
Contact person name
Physician Name
Physician's NPI Number
Physician's UPIN Number
E-mail address

G-1B Biochemistry and Genetics form and G-1C Maternal Serum Prenatal Triple Screen Form
The following information is needed to request a G-1B and or G-1C submission form:

Texas Provider Identifier Number (TPI)
National Provider Identification Number (NPI)
Provider Name · Mailing Address
City, State, Zip
Phone Number
Fax Number
Contact person name
Physician Name
Physician's NPI Number
Physician's UPIN Number
E-mail address

Last Updated January 26, 2007