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OFFICE OF LABORATORY SERVICES 167 11th Avenue South Charleston, WV 25303 PH: (304) 5583530 FX: (304) 5582006PLACE BARCODE HERE OLD USE ONLYMICROBIOLOGY LABORATORY SPECIMEN SUBMISSION FORMAT OF COLLECTION:PATIENT
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How to fill out influenza specimen submission form

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How to fill out influenza specimen submission form

01
Start by obtaining an influenza specimen submission form from a healthcare provider or laboratory.
02
Fill out your personal information accurately, including your name, date of birth, and contact information.
03
Provide information about your healthcare provider, including their name, address, and contact information.
04
Indicate the date and time the specimen was collected.
05
Specify the type of specimen being submitted, such as nasal swab or throat swab.
06
Fill out any relevant medical history or symptoms you may be experiencing.
07
Sign and date the form, affirming that the provided information is accurate and that you consent to the testing.
08
Return the completed form along with the specimen to the designated healthcare provider or laboratory.

Who needs influenza specimen submission form?

01
Anyone who suspects they may have influenza and wants to get tested should fill out an influenza specimen submission form. This includes individuals who are experiencing flu-like symptoms, such as fever, cough, sore throat, body aches, and fatigue. Healthcare providers may also require patients to fill out this form if they suspect influenza and want to confirm the diagnosis through laboratory testing.
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The influenza specimen submission form is a document used to submit samples of influenza viruses for testing and analysis.
Healthcare providers, laboratories, and other organizations collecting influenza samples are required to file the influenza specimen submission form.
To fill out the influenza specimen submission form, provide detailed information about the collected samples, including patient information, collection date, and any relevant symptoms.
The purpose of the influenza specimen submission form is to track and analyze influenza virus strains, monitor flu activity, and inform public health decisions.
The influenza specimen submission form requires reporting of patient demographics, sample collection details, testing methods used, and any relevant clinical information.
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