Test Request Forms
All request forms sent electronically must comply with the Privacy Act 1988, Health Records Act (Victoria) 2001 and the Information Privacy Act (Victoria) .
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You can view the Sample Collection and Transport Guidelines here.
Please select the relevant test for your sample type from the list below:
| FM Number (Download link) | Request forms for submission of samples |
|---|---|
| FM110 | National Enteric Pathogen Surveillance Scheme (NEPSS) - Human |
| FM116 | Public Health Investigation - Human samples |
| FM119 | Human Clinical sample referrral - single sample |
| FM377 | CBR Chain of Custody Form |
| FM979 | General chain of custody |
| FM1062 | Neisseria isolate submission |
| FM2085 | Listeria monocytogenes typing |
| FM2458 | Submission of suspected carbapenemase-producing organisms (CPO) - Human samples & CPO cultures |
| FM2753 | Human Clinical sample referral - multiple samples |
| FM2941 | Vancomycin Resistant Enterococcus (vanA) referral - single isolate |
| FM2942 | Vancomycin Resistant Enterococcus (vanA) referral - multiple isolates |
| FM2787 | Phylogeny and Analysis of WGS data |
| FM Number (Download link) | Request Form Name |
|---|---|
| FM114 | National Enteric Pathogen Surveillance Scheme (NEPSS) - Water |
| FM117 | Public Health Investigation - Water samples |
| FM377 | CBR Chain of Custody Form |
| FM979 | General chain of custody |
| FM1045 | Legionella chain of custody |
| FM1541 | Food and Water Chain of Custody Form |
| FM2085 | Listeria monocytogenes typing |
| FM2941 | Vancomycin Resistant Enterococcus (vanA) referral - single isolate |
| FM2942 | Vancomycin Resistant Enterococcus (vanA) referral - multiple isolates |
| FM Number (Download link) | Request Form Name |
|---|---|
| FM114 | National Enteric Pathogen Surveillance Scheme (NEPSS) - Environmental |
| FM117 | Public Health Investigation - Environmental samples |
| FM377 | CBR Chain of Custody Form |
| FM979 | General chain of custody |
| FM1885 | Public Health Investigation - Environmental samples, swabs & equipment |
| FM2085 | Listeria monocytogenes typing |
| FM2699 | Submission of suspected carbapenemase-producing organisms (CPO) - Environmental samples & CPO cultures |
| FM2941 | Vancomycin Resistant Enterococcus (vanA) referral - single isolate |
| FM2942 | Vancomycin Resistant Enterococcus (vanA) referral - multiple isolates |
| FM Number (Download link) | Request Form Name |
|---|---|
| FM112 | National Enteric Pathogen Surveillance Scheme (NEPSS) - Food & Pharmaceuticals |
| FM118 | Public Health Investigation - Food, food ingredient & packaging |
| FM377 | CBR Chain of Custody Form |
| FM979 | General chain of custody |
| FM1541 | Food and Water Chain of Custody Form |
| FM2085 | Listeria monocytogenes typing |