Coccidioidomycosis Serology Laboratory - Test Requisition Forms
Click the links below for descriptions of the tests offered and information on the submission of specimens.
Human Test Requisition Form (PDF)
Test Requisition Form Required Fields
- Patient Information: Full name, Date of Birth, Patient Identification Number, Sex (Legal) and Address
- Submitter’s Information: Full name of ordering provider, UC Davis Index or NPI number, Facility Information
- Specimen Information: Specimen Type or Source, Date and Time of Collection
- Test(s) requested
Note: Patient and Provider demographics are required for all state reportable lab reports. Per Title 17, California Code of Regulations (CCR), Section 2505 - Reportable Conditions: Notification by Laboratories to Public Health). Submission of incomplete test requisition forms may result in testing delays.
Veterinary Test Requisition Form (PDF) - Effective November 1, 2022
Test Requisition Form Required Fields
- Patient Information: Full name, Sex, Date of birth (if known or approximate)
- Submitter’s Information: Full name of ordering provider, Facility Information
- Specimen Information: Specimen Type or Source, Date of Collection
- Test(s) requested
TIME SENSITIVE ALERT of an upcoming regulatory compliance deadline (PDF) effective April 1, 2024.
Karryn Doyle, CCEP