UC Davis Health
Center for Valley Fever

Serology Laboratory Test Requisition | Center for Valley Fever | UC Davis Health

Test Requisition

Coccidioidomycosis Serology Laboratory Test Requisition Forms

Human Test Requisition Form (PDF)

Test Requisition Form Required Fields

  1. Patient Information: Full name, Date of Birth, Patient Identification Number, Sex (Legal), and Address
  2. Submitter’s Information: Full name of ordering provider, UC Davis Index or NPI number, Facility Information
  3. Specimen Information: Specimen Type or Source, Date and Time of Collection
  4. 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 delays in testing.

 Veterinary Test Requisition Form (PDF) - Effective November 1, 2022

Test Requisition Form Required Fields

  1. Patient Information: Full name, Sex, Date of birth (if known or approximate)
  2. Submitter’s Information: Full name of ordering provider, Facility Information
  3. Specimen Information: Specimen Type or Source, Date of Collection
  4. Test(s) requested