Clinical Testing Requisition Form (DOH-49)
Pediatric HIV Testing Requisition Form (DOH-3917)

Specimen collection kits can be requested by calling the NYSDOH Wadsworth Center Order Desk at (518)-474-4175. These kits provide supplies for shipping whole blood specimens at room temperature to the Bloodborne Viruses Laboratory. Submitters must provide insulated shippers and other supplies for specimens that need to be shipped on cold packs or on dry ice. Kits are available for Pediatric HIV testing and Clinical HIV/HCV Testing. Kits include:

• lavender-top EDTA blood collection tubes
• materials for shipping specimens at room temperature 
• UPS shipping label (Pediatric HIV testing kit only)

1. Requisition form: Fill in the requisition form (DOH-3917 for pediatric HIV testing and DOH-49 for other testing) as completely as possible, including test requested and all required fields.  For transgender individuals, please indicate gender at time of testing.  Include previous test results and other clinical information that may help us to interpret results.  Please write legibly. 
2. Specimen labeling: Label each specimen with two unique identifiers (name, date of birth, patient number) and collection date.  These identifiers must match the requisition form exactly.  A unique identifying code may be used for anonymous HIV testing; however this testing may only be requested from NYSDOH-approved anonymous testing sites.  Failure to properly label the sample will result in rejection of the sample and a request will be made for another specimen. 
3. Specimen collection and shipping: See table for collection and shipping instructions for preferred specimen types.  Collect a full tube to allow all necessary tests to be completed.  Contact the laboratory at 518-474-2163 for instructions for submitting blood tubes not specified below.  Package tubes according to the directions supplied with the specimen mailing kit or according to IATA regulations.  We recommend sending specimens by courier; U.S. Postal Service shipping is not recommended.  The laboratory receives specimens Mon – Fri; please ship with this in mind.  

* Submitters must provide insulated shipper and other supplies for shipping specimens on cold packs or on dry ice.

Pediatric Samples: The pediatric testing kit includes a prepaid shipping label for UPS Ground Shipping.  Submitters can use this label to ship pediatric specimens to the BVL at no cost.

Other Whole Blood Samples: UPS has approved the use of New York State (NYS) contract pricing for customers shipping whole blood specimens to our laboratory. Specimen shippers may be sent by UPS Ground from within NYS at minimal cost with guaranteed delivery to our laboratory within 1-2 business days. To access these UPS shipping rates, you will need to set up a UPS account linked to NYS pricing. Then, when you ship specimens to the Wadsworth Center using this UPS account number, you will be billed for the shipping charges at reduced contract rates. Please note that Wadsworth Center is not offering to pay for specimen shipping. Instead, we are offering access to reduced UPS shipping rates for specimen shipments to the BVL.  If you have questions please contact the laboratory.

New York State HIV rapid testing sites must register with the New York State Department of Health (NYSDOH) before submitting dried blood spot (DBS) specimens to the Bloodborne Viruses Laboratory for HIV antibody confirmation.  Training on DBS collection and shipping procedures will be provided by the NYSDOH AIDS Institute.  For more information contact: Mara San Antonio-Gaddy at the NYSDOH AIDS Institute at (518) 474-3671.

Requisition form: Fill in the requisition form (DOH-49), completing all required fields. In section 1, Test Requested, check ‘HIV Diagnostic Testing’ and ‘HIV Rapid Test Confirmation’. In section 5, Specimen Information, check ‘Dried blood spot’. Include previous test results and other clinical information that may help us to interpret results. Please write legibly. 

DBS collection and shipping procedures

1. Label the Specimen Collection Card with client name and collection date before opening the card to expose the blotter paper.  Lift the flap where shown to open the card.  The blotter paper should not lay flat against the work surface when used.  To angle it slightly above the work surface, gently bend the flap away from the back side of the blotter paper when opening the card.
2. Perform the fingerstick and have the client hold his/her finger over (not touching) a circle on the DBS card while a large drop of blood forms.  Allow drop to fall into the circle; do not layer blood drops in the same circle. Blood may extend slightly beyond the circle. Collect as many circles on the DBS card as possible.
3. Card must dry at least 4 hours and no more than 24 hours prior to mailing. Allowances can be made when mailing delays occur because of weekends or holidays.
   
   1. On-site specimen collection: When the collection is complete, slightly bend card away from cover. This will increase the angle, so adequate air flows beneath the blotter paper when the card is placed on a flat surface to dry. Wet blood spots should not contact any surface. Dry for 4 hours and proceed to step 4.
   2. Off-site specimen collection: Use these instructions if you need to transport the DBS card before it is completely dry, i.e. within 4 hours of collection.
      
      1. Dry card as long as possible following instructions in Step 3a.
      2. Then fold the cover under the sample and tuck into flap.
      3. The cover should not touch the filled circles before 4 hours have elapsed.
      4. Ensure the blood spots are slightly angled so they don’t lay flat against the box bottom.
      5. Place fresh glassine paper on the bottom of the drying box and then place card on top with blood spots facing up.
      6. Do not place anything on top of the blood spots.
      7. Cover the box with the lid ensuring that the air holes are facing up and unobstructed.
      8. Continue to store blood spots in box until they have dried for at least 4 hours then proceed to step 4.
4. After drying for 4 hours, discard the glassine paper, if used.
5. Then fold the DBS card at the crease line and tuck cover over blood spots.
6. Verify information on DBS card and lab requisition match exactly.
7. Place the dried blood spot card and completed test requisition (DOH-49) in a plain envelope.
8. To ensure correct delivery of the specimen, make sure envelope is addressed to (preprinted labels are recommended):
   Monica Parker, PhD.
   NYSDOH - Wadsworth Center
   David Axelrod Institute
   PO Box 22002
   Albany, NY 12201-2002
9. Multiple DBS specimen cards may be sent in same envelope. Affix sufficient postage and send via first class mail using US Postal Service.
10. Put envelope in an indoor mailbox to avoid extremes in temperatures.

There are significant advantages to accessing test results on the Health Commerce System (HCS) and the Clinical Laboratory Information Management System (CLIMS) including specimen tracking, e-mail notification when results become available and online access to test results

1. Set up a HCS account and receive a HCS User ID: Contact the Commerce Account Management Unit at 1-866-529-1890 (Option 1) to identify the HIN/HPN coordinator for your facility and to get assistance in setting up a HCS account. Submitters who already have an existing HCS account for ordering testing materials or other purposes can use their existing HCS User ID.
2. Obtain HIV/HCV report permissions on CLIMS: Clinical laboratories, county health departments and Department of Corrections and Community Supervision (DOCCS) should contact the HIN/HPN coordinator at their facility and ask for access to the “Wadsworth HIV/HCV Results Coordinator” role. Submitters from all other facilities should complete the “Request for Access to the Wadsworth Center Laboratory Information Management System (CLIMS)” form (DOH-4250), sign the form, and fax it to (518) 474-8140 or (518) 473-1326. 
3. Track receipt of specimens and access test reports: Log into the HCS, click on the CLIMS application and select either ‘Specimen Reports’ or ‘Specimen Receipts’. Reports will be available on the HCS for 90 days. To set up email notifications click on ‘My Preferences’ and enable email notification.