Laboratory Testing Services Manual - Forms and Laboratory Fee Schedule
Forms
- Order Forms for Laboratory Mailing Containers and Supplies
- Test Request Form Samples and G-9 Form - Laboratory Services
- Obtaining Specimen Submission Forms by Email
Fees
If you have trouble viewing any of the documents below, please contact the HHS Accessibility Office, at Accessibility@hhsc.state.tx.us.
Order Forms for Laboratory Mailing Containers and Supplies
Phone: 512-776-7661
Fax: 512-776-7672
Some of these forms are in PDF format. View the file viewing information. Supplies are provided only for testing performed at the DSHS Laboratory.
| Form # | Name |
|---|---|
| G-6A | Order Form for General Supplies Revised: 01/2021 |
| G-6C | Order Form for Gonorrhea/Chlamydia (GC/CT) Laboratory Supplies Revised: 09/2019 |
| G-399 | Order Form for Child Health Laboratory Supplies Revised: 08/2018 |
| G-6D | Order Form for Newborn Screening Supplies Revised: 01/2022 |
| G-6E | Order Form for PKU Monitoring Supplies Medical Providers: To order supplies for PKU Monitoring, contact DSHS Container Preparation Group at 1-888-963-7111 ext. 7661. Patients: Please contact your metabolic physician or metabolic clinic to get additional PKU Monitoring collection supplies. |
| G-6F | Order Form for TB Supplies Revised: 01/2021 |
Submitter Account Request Forms
Phone No. 512-776-7578
FAX No. 512-776-7533
Note: Unless otherwise noted, these are sample forms only. To receive specimen submission forms with your submitter identification, please request forms by email or by phone. If you do not yet have a submitter identification number, please complete and submit the Submitter Identification (ID) Number Request Form.
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. The sample form should then print normally.
Test Request Form Samples and Master Forms
Program Descriptions for Laboratory Forms
Submitter Identification (ID) Number Request Form, revised: 07/2022
Remote Data Services Facility Security Agreement, Revised: 4/2020
Remote Data Services User Agreement, Revised: 04/2020
Specimen Submission Forms
Obtaining Specimen Submission Forms by Email
Email request to Laboratory Forms. Please provide the 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
- Email address
G-1B Specimen Submission Form and G-THSTEPS Specimen Submission Form
The following information is needed to request a G-1B or G-THSTEPS 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
- Email address