Requisitions and Forms

REQUISITION REVISION DATE
Clinical Submission Requisition Form (PH-4182) 8/2022
COVID-19 Requisition Form (PH-4360) 8/2022

Influenza and Viral Respiratory Panel Requisition Form (PH-4149) 

RESTRICTED TO:  Sentinal Provider Network (SPN), EIP Influenza Hospitals, and the Office of the Medical Examiner.

8/2022

Rabies Requisition (PH-4177)  

RESTRICTED TO:  Public Health Departments, Veterinary Clinics, and those who have received prior authorization for testing from Epidemiology.

9/2014

Select Agent Rule Out Requisition Form (PH-4263)

 For Sentinel Laboratory Use - Notification required PRIOR to sample submission

8/2022
Laboratory Supplies Requisition - Nashville Central Laboratory (PH-1580A) 12/2022
Laboratory Supplies Requisition - Knoxville Regional Laboratory (PH-1580C) 12/2022