Fillable COVID-19 Chain of Custody DC Public Health Laboratory (Government of the District of Columbia)

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COVID-19 Chain of Custody DC Public Health Laboratory (Government of the District of Columbia)

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District of Columbia Department of Forensic Sciences Public Health Laboratory
401 E Street SW 4
th
Floor Washington, DC 20024 Voice (202) 481-3419 Fax (202) 481-3464
General Laboratory External Chain of Custody
PHL CLIA Director: Julia Kiehlbauch Ph.D., D(ABMM)
CLIA#: 09D0968273
L
ast Updated: 02/04/2021
DC Public Health Laboratory
COVID-19 Chain of Custody
Specimens Submitted by:
Specimens Received by:
Hospital/Clinic
Courier Signature:
Submitter Name:
Phone:
Fax:
Date :
Time:
Date:
Time:
#
Unique
Specimen
Identifier (e.g.,
MRN, sample
ID)
DC Health
Outbreak
Code
(if available)
Race/ethnicity
Date of
Birth
Sex Travel History
Collection
Date
Sample
Ct Value
Comments
1
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COVID-19 Chain of Custody DC Public Health Laboratory (Government of the District of Columbia)

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Completed 31 March 2021

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