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Submission of Specimens for 2019?nCoV (COVID-19) Testing at the New York City Public Health Laboratory (PHL)

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Instructions for Submission of Specimens for 2019‐nCoV (COVID-19)
Testing at the New York City Public Health Laboratory (PHL)
NOTE: These instructions apply AFTER approval has been given (via conference call with a medical epidemiologist from the
New York City Department of Health and Mental Hygiene {NYC DOHMH}) to test a patient for 2019‐nCoV (COVID-19) virus
infection. Please call the Provider Access Line at 1‐866‐692‐3641 for consultation or to report a suspected 2019-nCoV
(COVID-19) case. When 2019‐nCoV testing has been authorized, hospitals may request a specimen collection kit from the PHL.
1. Complete the requisition form (“Laboratory Test Request” form)
• No specimen will be tested without a completed “Laboratory Test Request” form.
• EACH SPECIMEN requires its own form.
For example, if you are submitting two upper respiratory tract specimens, oropharyngeal and
nasopharyngeal swabs combined in one Viral Transport Medium (VTM) tube and a lower respiratory
specimen for the same patient, you need to complete TWO forms, one for each specimen.
• All starred (*) fields are REQUIRED.
Failure to complete all required fields will result in delays in testing or the specimen may be rejected.
• Place the form inside the outer pouch of the specimen bag.
• Place only one 2019-nCoV (COVID-19) specimen and one form per bag.
2. Collect both specimen types
• Upper respiratory tract swabs: collect ONE Nasopharyngeal (NP) swab and ONE Oropharyngeal (OP)
swab, and combine them into ONE VTM tube. Swabs must be synthetic (non‐cotton), non-absorbent,
and flocked, and placed in liquid VTM. Swabs NOT in VTM are NOT acceptable. Place the NP swab and
the OP swab together in ONE tube and submit one form for this combined OP and NP specimen.
• Lower respiratory tract specimen (sputum, tracheal aspirate or bronchoalveolar lavage).
For detailed instructions on specimen collection, please refer to “Interim Guidelines for Collecting,
Handling, and Testing Clinical Specimens from Patients Under Investigation (PUIs) for Coronavirus Disease
2019 (COVID-19)": https://www.cdc.gov/coronavirus/2019-nCoV/guidelines-clinical-specimens.html
3. Label the specimen
• Failure to properly label the specimen will result in rejection and the specimen will not be tested.*
• Specimen tubes MUST be labeled with:
o Patient’s First and Last Names
o Patient’s Date of Birth
o Date of C
ollection
o Specimen Source
• All information
on the specimen label must EXACTLY MATCH the information on the Laboratory Test
Request form, including the spelling of the patient’s first and last names.
4. Specimen handling
• Keep specimens refrigerated while awaiting transport.
• Transport with cold ice packs if the specimens are transported within 72 hours from the time of
specimen collection. If exceeding 72 hours, freeze at ‐70°C and transport on dry ice.
• Follow shipping regulations for UN 3373 Biological Substance, Category B when sending potential
2019‐nCoV (COVID-19) specimens.
New York City Department of Health and Mental
Hygiene
PUBLIC HEALTH
LAB
ORAT
ORY
Jennifer Rakeman, Ph.D., Assistant Commission
er
455 First Avenue New York, NY
10016
NYS CLEP PERMIT # : PFI 3849 CLIA #:
33D0679872
LABORATORY TEST
REQUEST
Microbiology Section: Tel 212‐447‐6783 Fax
212‐447‐8258
Virology Section: Tel 212‐447‐2864 Fax
212‐447‐2877
PHL USE ONLY
•
Failure to complete all required (*) fields may result in specimen being rejected
• Spelling of patient name and DOB on form must exactly match that on specimen container
• Complete a separate Laboratory Test Request form for each specimen
PATIENT INFORMATION
*Required Information
LAST NAME
*
FIRST NAME
*
MIDDLE INITIAL
DATE OF BIRTH
*
(MM/DD/YYYY)
SEX*
Male Female
PATIENT ID NUMBER
PATIENT MEDICAL
RECORD NUMBER*
ADDRESS CITY STATE ZIP
TELEPHONE
PHYSICIAN
(if not submitter include
contact info)
SUBMITTER INFORMATION
NAME OF SUBMITTING HOSPITAL, LABORATORY, or OTHER FACILITY
*
PROVIDER ID #
PRIMARY CONTACT
or PHYSICIAN
LAST NAME
*
FIRST NAME
*
ADDRESS (including bldg. and room)*
CITY
*
STATE
*
ZIP
*
TELEPHONE
*
PAGER/CELL
*
FAX*
EMAIL
SPECIMEN INFORMATION
DATE OF COLLECTION
*
(MM/DD/YYYY):
TIME OF COLLECTION (00:00):
A
M PM
A. DOHMH bureau
BCD
DOHMH INVESTIGATION CODE:
Additional comments/
Clinical syndrome/
Exposure/Travel History
Test request: 2019‐nCoV (COVID-19) RT‐PCR
Lower respiratory
Upper respiratory
Specimen
Container
Sterile Container Swabs in Viral Transport Media
Specimen
Source
Bronchoalveolar Lavage
OR
Tracheal Aspirate
OR
Sputum
Nasopharyngeal/
Oropharyngeal
swabs combined in
one tube
Note: NP swab and OP swab
should be combined in one tube
with VTM
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Completed 26 March 2020

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