Phone: 888-634-5227-2026

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The document is a Microbiology Specimen Submission Form from the Ohio Department of Health Laboratory, detailing the necessary information required for submitting microbiological specimens. It includes sections for patient and submitter information, specimen details, and requested examinations, with specific instructions on completion and contact information for further inquiries.

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Click ‘Get Form’ to open the Microbiology Specimen Submission Form in the editor.
Begin with Section 1: Patient Information. Fill in the required fields marked with an asterisk (*), including Patient Name, Date of Birth, and Sex. Ensure all information is accurate for proper processing.
Proceed to Section 2: Submitter Information. Complete the Agency Name, Contact Name, and Phone Number fields. These details are crucial for communication regarding the specimen.
In Section 3: Specimen Information, indicate the Collection Date and select the Specimen Type that applies. Be thorough in checking all relevant options to ensure clarity on what is being submitted.
Finally, review Section 4: Exam Requested. Check all applicable tests needed for your submission. Remember that ODH approval is required prior to submission; contact them if necessary.

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