Infectious Disease Requisition Form (DOH-4463)
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:

   For all testing except pediatric HIV diagnostic testing, complete the Infectious Disease Requisition (IDR) form DOH-4463. Complete all required fields marked with an asterisk *. In addition, please complete race, ethnicity, current gender identity, ordering health care provider’s full name, address and National Provider Identifier (NPI). For rapid test confirmation, also check HIV diagnostic testing or HCV RNA, as appropriate, and enter the rapid test type in ‘Submitter Lab Findings’.  For HIV-2 RNA testing, indicate Qualitative (diagnostic) or Quantitative (viral load).  If applicable, enter relevant treatment (e.g. ARV treatment, PrEP) and pregnancy status with trimester in the appropriate Clinical History fields.     

   For pediatric HIV diagnostic testing complete the Pediatric HIV Testing Requisition form (DOH-3917) following instructions provided with the form. Please write legibly. 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 agencies conducting HIV and HCV rapid testing must register with the New York State Department of Health (NYSDOH) before submitting dried blood spot (DBS) specimens to the Bloodborne Viruses Laboratory for confirmation.  Training on DBS collection and shipping procedures will be provided by the NYSDOH AIDS Institute.  For more information contact: RTPAI@health.ny.gov.

Requisition form:

Complete the Infectious Disease Requisition (IDR) form DOH-4463. Complete all required fields marked with an asterisk *. In addition, please complete race, ethnicity, current gender identity, ordering health care provider’s full name, address and National Provider Identifier (NPI).

In the Specimen Information section, enter “Dried blood spot” in the Source field.

In the Laboratory Examination Requested section, enter the rapid test type in ‘Submitter Lab Findings’ and check ‘HIV/HCV’. For HIV confirmation, also check ‘rapid test confirmation’ and ‘HIV diagnostic testing’.  For HCV confirmation, also check ‘rapid test confirmation’ and ‘HCV RNA’. 

In the Clinical History section, if applicable, enter relevant treatment (e.g. ARV treatment, PrEP) and pregnancy status with trimester.     

DBS collection and shipping procedures

Before collecting and shipping DBS, please refer to instructions and training materials provided by the NYSDOH. Patient identifiers on the DBS card must match those on the requisition form. DBS must be received and processed by the laboratory within 15 days of collection. Ship DBS specimens to the address below and include ‘Bloodborne Viruses Laboratory’ in the address, as shown, to ensure the package is routed to the appropriate laboratory section.

Shipping Address
Bloodborne Viruses Laboratory
David Axelrod Institute
Wadsworth Center, NYSDOH
120 New Scotland Avenue
Albany, NY 12208

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.