Download a test requisition form from the selection below:

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• Blood Lead Test Request DCH-0696 (DCH-0696 fillable  [This fillable form works best if you download it prior to using ]) - updated 9/12/2007
• CD4/CD8 & HIV-1 Viral Load Testing DCH-0562- updated 4/3/2009
• CDC Submission Form, CDC 50.34
• CDC Lyme Disease Case Report Form, CDC 52.60
• Environmental Lead Sampling DCH-0558(DCH-0558 fillable [This fillable form works best if you download it prior to using] ) - updated 7/25/2008
• HIV-1 Genotyping DCH-0562- updated 4/3/2009
• Microbiology/Virology DCH-0583  (DCH-0583 fillable) - updated 9/11/2009
• Multiple Patient/Sample - Same Test DCH-1052 (fillable form)
• Rabies Testing - Lower Peninsula  DCH-1053
• Rabies Testing - Upper Peninsula DCH-1438 
• Regional Laboratories DCH-0567  (DCH-0567 fillable) - updated 11/21/2008
• Sentinel Physician DCH-1583Sent - updated 9/11/2009
• Trace Metals Test Requisition DCH-0976
• Upper Penninsula Laboratory - Microbiology DCH-0572- updated 6/19/2008
• Vaccinia/Variola/Pox Virus DCH-1396 - updated 6/19/2008

The following test requisitions cannot be downloaded from this site. To order, please contact Craig Fedewa at the MDCH Lab Support Unit by Fax 517-335- 9039, phone 517-335-9040, or E-mail at FedewaC@michigan.gov.

• Dried Blood Spot; HIV - DCH-0698
• Chlamydia trachomatis/Neisseria gonorrhoeae (non-culture), DCH-1248

The following test requisitions must be ordered by contacting Accounting, as there is a fee associated with the testing. Please call 517-241-5583 for more information.

• Health Care Worker Immune Status Testing- DCH-0460
• Hepatitis C Antibody Screen - FB-202
• Hepatitis C Confirmation - FB-203
• Medical/Nursing Student Antibody Testing - DCH-0459
• Newborn Screening - DCH-1153 and DCH-1154

The following (pre-paid) test requisitions are distributed by the Sexually Transmitted Diseases Section (517-241-0870).

• N. gonorrhoeae and C. trachomatis - Combination - DCH-1167
• C. trachomatis only - DCH-1167

The following test requisition cannot be downloaded from this site. For details regarding ordering, please contact Dr. Bonnie Taffe at 517-335-9490 for more details.

• PBB, PCB, PBDE, and Pesticides Requisition- DCH-0571

Rev.  9/11/2009