DHHS → MeCDC → Division of Public Health Systems → HETL → HETL Sections → Clinical Microbiology → Downloadable Forms
Information
Clinical Microbiology Forms and Information
Requisitions
- HETL Clinical Requisition (front) (PDF)
- SARS CoV-2 (COVID-19) Priority Specimen Submission Form (PDF) - Updated January 7, 2022
- HETL Rabies Submission Form (Word)
- Human Arbovirus Specimen Submission Form - (PDF) - This fillable form must be submitted with all arboviral panel test requests.
- CDC DASH form 50.34
- Orthopox Specimen Submissions Form (PDF) Updated July 28, 2022
SARS-CoV-2 Swab and Send Documents
- HETL Swab and Transport Media Chart (PDF)
- Self Collection for SARS-CoV-2 Testing at HETL (Word)
- Self Collection Quality Assurance Worksheet (PDF)
Ordering Supplies
- Request for Viral Culture / PCR Supplies (PDF)
- Request for Blood Lead Analysis Supplies (PDF)
- Request for Micro Supplies (PDF)
- Instruction for shipping patient specimens to HETL using HETL provided shipping materials (PDF)
Other
- Change to Guidelines for Specimen Collection Tubes for Venous Whole Blood Lead Samples Submitted to Maine’s Health and Environmental Testing Laboratory (HETL) (PDF)
- HETL Microbiology Pricing and Applicable CPT Codes (PDF)
- Fax Only Consent Form (PDF)
- Current Copy HETL's CLIA Certificate (PDF)
- 2022 Laboratory Reporting of Notifiable Conditions (PDF)
- Notice of Privacy practices (Word)
Tuberculosis
- TB Bill Submitter Letter 2018 (Word)
- TB Quantiferon® IGRA Clinician's Guide (PDF)
- TB Quantiferon® IGRA Blood Collection quick guide (PDF)
- TB Quantiferon® IGRA Technical Note on Filling Tubes (PDF)
- CDC IGRA Guidelines MMWR June 2010 (PDF)
