Completing the Rabies Specimen Requisition Form

 

WSLH Rabies Requisition Form (PDF)

(To order WSLH requisition forms with your facility’s name and address preprinted, contact the Clinical Orders Department at 800-862-1088.)

  • Complete a WSLH rabies requisition form for each specimen in a shipment; complete information is required for effective follow-up of rabies exposures by the Wisconsin Division of Public Health, the Wisconsin Department of Agriculture, Trade and Consumer Protection, the WSLH and local health departments.
  • In cases of human exposure, include the name, address and phone number of the physician who will take responsibility for patient care so the rabies laboratory result can be rapidly reported.
  • Include the name and address of the submitter (e.g., veterinary clinic, humane society, etc.) on the requisition form, otherwise the submitter will not receive a laboratory report.
  • Clearly document on the requisition forms if multiple specimens are submitted in one shipping container to ensure that all specimens are tested.
  • If specimens from different exposure cases are submitted in the same shipping container, clearly identify (on the specimen and the form) which specimen is associated with each case.
  • Completed specimen requisition forms should be placed on top of the lid of the foam container, not inside the shipping container with the specimens where they could become contaminated.