Maine Health and Environmental Testing Lab - Water - Maine 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the *Submitter Name/Address and Hospital/Lab ID# fields. Ensure all required fields marked with an asterisk are completed accurately.
3. Next, provide the Physician's details including Name, Fax, Practice/Affiliation, Address, Phone, and NPI#. This information is crucial for processing your request.
4. Fill in the *Patient Name (Last, First, MI), Gender, and Date of Birth. Indicate if the patient is hospitalized and provide the Symptom Onset Date if applicable.
5. Select the appropriate *Specimen source from the provided options. Make sure to enter the *Date of Collection accurately.
6. Complete the Patient's address details including Street Address, Apt#, City/Town, State, and Zip Code. Also indicate Race and Ethnicity as required.
7. If applicable, fill out Blood Lead testing information including Parent/Guardian details and any necessary insurance coverage information.
8. Finally, review all entries for accuracy before submitting your form through our platform for seamless processing.

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