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Test Request Forms

Test Request Forms

The Bureau of Laboratories' test requisitions are updated regularly.

Please download and use the most recent version from the selections below: 

For best printing of PDF forms, use the print button on the PDF instead of your browser's print button. Please note that most forms are more than one page. It is essential to print and submit the entire form.

  • Blood lead test request, DCH-0696 (Rev 6-22)
  • CD4/CD8 & HIV-1 viral load testing, MDHHS-6084 (Rev 11-25)
  • Centers for Disease Control and Prevention (CDC) Specimen Submission 

    NOTE: Please be advised that the CDC is retiring the 50.34 Specimen Submission form on October 30, 2026, in an effort to modernize and streamline the specimen submission process. The CDC Specimen Test Order and Reporting (CSTOR) web portal is the CDC's preferred method of specimen submission. If your organization is onboarded to CSTOR, no further action is needed. If you require support, please contact the CSTOR team at CSTOR@cdc.gov.

  • Chlamydia trachomatis/Neisseria gonorrhoeae/Trichomonas vaginalis (non-culture), DCH-1248 (Rev 8-26)
  • Environmental Lead Sampling, DCH-0558 (Rev 8-25)
  • Genomic Sequencing, MDHHS-6129 (Rev 5-25)
  • Influenza SARS-CoV-2 Multiplex Assay, MDHHS-6097 (Rev 7-25)
  • Microbiology/Virology, DCH-0583 (Rev 01-19) NOTE: This is a two-page form. Both pages must be printed, completed and submitted to avoid testing delays.   
  • Multiple Patient/Sample - Same Test DCH-1052 (Rev 6-22) (Food Outbreak or Non-Human Specimens Only)
  • Rabies Testing, DCH-1053 (Rev 4-26)
  • Respiratory Surveillance, DCH-1583 (Rev 10-26)
  • Tick Identification and Test Instructions (Rev 03-21)
  • Vaccinia/Variola/Pox Virus, DCH-1396 (Rev 3-22)
  • Viral Respiratory Testing, MDHHS-6097 (Rev 7-25)
  • Virology/Serology Testing, MDHHS-6084 (Rev 11-25)
 
The following test requisitions cannot be downloaded from this site. Ordering instructions are listed for each requisition. 
There is a fee associated with some testing. The following test requisitions must be ordered from Accounting:
  • Medical/Nursing Student/Healthcare Worker Immune Status Antibody Testing - DCH-0459. To order, please email MDHHS-ImmuneStatusTestingRequest@michigan.gov.
  • Newborn Screening - DCH-1153 and DCH-1154 To order, please call 517-335-8110
The following (pre-paid) test requisition is distributed by the Sexually Transmitted Diseases Section. Please call 517-241-0870.
  • N. gonorrhoeae and C. trachomatis - Combination - DCH-1167C
 

Rev 10/29/2026