User Responsibility. As a user of the site, you are responsible for the content, material, and information you enter into the system. Your use of the site is limited based on your user access. You are not authorized to access, use, or disclose any content, material or information in the site that is not related to samples that you or your organization have submitted for testing. You are responsible for ensuring that access to patient and testing information through LabOnline is only provided to authorized medical personnel. You are responsible for ensuring that LabOnline is being used properly by your facility’s users. You will communicate any employment status changes or any adjustments to user accounts needed to DC PHL. The facility must review user access to LabOnline every 30 days. Unauthorized access, use, or disclosure of any content, material or information in the site can result in termination of your access to the site and referral to appropriate authorities. Your password is also your responsibility. It is always important to keep your password confidential. If you forget your username or password, please use the “forgot password” feature on the site or contact us at XXX-XxxXxxxxx@xx.xxx. The DC PHL reserves the right to change or replace these Terms of Use or to impose new conditions on the use of the site in which case it will post the revised Terms of Use and update the revision date to reflect the effective date of the changes. The DC PHL reserves the right to deny access to the site or any features of the site to anyone who violates these Terms of Use. I have read the above LabOnline user agreement and agree to adhere to these requirements. By accepting the Terms of Use, I represent and agree: (i) that I am 18 years of age or older, (ii) to comply with these Terms, all applicable laws and regulations, (iii) to use the Site in accordance with these Terms, the Privacy Notice, and any additional term referenced herein; and (iv) that any content, material or information I submit through the Site will not violate the rights of, or cause injury to, any person or entity. User Printed Name and Title User Signature Date Forensic Science Laboratory | Public Health Laboratory | Crime Scene Sciences 000 X Xxxxxx XX, Xxxxxxxxxx, XX 00000 Last Updated: 03/04/2022 District of Columbia ● Department of Forensic Sciences ● Public Health Laboratory 000 X Xxxxxx XX ● 4th Floor ●Washington, DC 20024 ● Phone (000) 000-0000 ● Fax (000) 000-0000 LabOnline Request Form CLIA Laboratory Director: Xxxxxxx X. Xxxxxx, Ph.D., D(ABMM), MLS(ASCP)CM CLIA#: 09D0968273 Type of LabOnline Facility Access Requested *Required Information Full access- Test Ordering and Result/Report Access Partial access- Test Ordering ONLY Submitter Information Name of Submitting Hospital, Laboratory, or other Facility* Address* City* State* Zip* Facility Health Care Provider Last and First Name* Facility Health Care Provider NPI #* User Last and First Name* User Telephone Number* User Secure Fax Number* User Secure Email* Testing- please select the test(s) that your facility expects to be requesting from DC PHL MICROBIOLOGY/GENERAL BACTERIOLOGY MOLECULAR/VIROLOGY OCME COVID-19 (NAAT) Gonococcal Isolate Surveillance (GISP) Novel Influenza (PCR) + Referred Isolates Chlamydia trachomatis/Neisseria gonorrhoeae (TMA) (Salmonella, Vibrio, Shigella, Listeria, Campylobacter, E.coli (STECand EIEC), CRE, C. auris) Respiratory Virus Panel SEROLOGY Mumps (PCR) + Measles (IgG) + Measles Virus (PCR) + SARS-CoV-2(IgG) + Middle East Respiratory Syndrome (MERS-CoV)(PCR) + TOXICOLOGY Xxxx Virus Assay (NAAT)(TMA) Drug of Abuse Screening Panel (14 drug panel) § Flu/SC2 Surveillance (PCR) OTHER TEST Direct Referral (for testing not conducted at DC PHL) Please specify test name: + DC Health must approve testing prior to sending any isolate or specimen to the DC Public Health Laboratory. § Call the DC Public Health Laboratory prior to sending any specimens. This section is for DC PHL use only Approved/Reviewed by: Printed Name and Title Active Deactivated Signature Date Date Deactivated: Forensic Science Laboratory | Public Health Laboratory | Crime Scene Sciences 000 X Xxxxxx XX, Xxxxxxxxxx, XX 00000
Appears in 1 contract
Samples: dfs.dc.gov
User Responsibility. As a user of the siteSite, you are responsible for the content, material, and information you enter into the system. Your use of the site Site is limited based on your user accessstatus. You are not authorized to access, use, or disclose any content, material or information in the site Site that is not related to samples that you or your organization have submitted for testing. You are responsible for ensuring that access to patient and testing information through LabOnline is only provided to authorized medical personnel. You are responsible for ensuring that LabOnline is being used properly by your facility’s 's users. You will communicate any employment status changes or any adjustments to user accounts needed to DC PHLthe DCPHL. The facility must review user access to LabOnline every 30 days. Unauthorized access, use, or disclosure of any content, material or information in the site Site can result in termination of your access to the site tote Site and referral to appropriate authorities. Your password is also your responsibility. It is always important to keep your password confidential. If you forget your username or password, please use the “forgot password” feature on the site Site or contact us at XXX-XxxXxxxxx@xx.xxx. The DC PHL reserves the right to change or replace these Terms of Use or to impose new conditions on the use of the site Site in which case it will post the revised Terms of Use and update the revision date to reflect the effective date of the changes. The DC PHL reserves the right to deny access to the site Site or any features of the site Site to anyone who violates these Terms of Use. I have read the above LabOnline user agreement and agree to adhere to these requirements. By accepting the Terms of Use, I you represent and agree: (i) that I am you are 18 years of age or older, (ii) to comply with these Terms, all applicable laws and regulations, (iii) to use the Site in accordance with these Terms, the Privacy Notice, and any additional term referenced herein; and (iv) that any content, material or information I you submit through the Site will not violate the rights of, or cause injury to, any person or entity. DC Public Health Laboratory User Printed Name name and Title Date User Signature Date Forensic Science Laboratory | Public Health Laboratory | Crime Scene Sciences 000 X Xxxxxx XX, Xxxxxxxxxx, XX 00000 Last Updated: 03/04/2022 District of Columbia ● Department of Forensic Sciences ● Public Health Laboratory 000 X Xxxxxx XX ● 4th Floor ●Washington, This section is for DC 20024 ● Phone (000) 000-0000 ● Fax (000) 000-0000 PHL use only Printed name and Title Date Signature Date LabOnline Client Request Form CLIA Laboratory Director: Xxxxxxx X. Xxxxxx, Ph.D., D(ABMM), MLS(ASCP)CM CLIA#: 09D0968273 Type of LabOnline Facility Access Requested *Required Information Would you like to request a virtual LabOnline training for your facility? * Yes No LabOnline Access Type* Partial access- Test Ordering ONLY Full access- Test Ordering and Result/Report Access Partial access- Test Ordering ONLY Submitter Information Name of Submitting Hospital, Laboratory, or other Facility* HealthCare Provider NPI #* Health Care Provider* Last Name* First Name* Primary Person of Contact* Last name: First Name: Address* City* State* Zip* Facility Health Care Provider Last and First Name* Facility Health Care Provider NPI Telephone #* User Last and First Name* User Telephone Number* User (primary) Secure Fax Number#* User Secure Email* Testing- please select the test(s) clinical testing that your facility expects to be requesting from sending to DC PHL MICROBIOLOGY/GENERAL BACTERIOLOGY MOLECULAR/VIROLOGY MOLECULAR OCME COVID-19 (NAAT) Gonococcal Isolate Surveillance (GISP) Referred Isolates Novel Influenza (PCR) + Referred Isolates PCR)+ VIRAL CULTURE Chlamydia trachomatis/trachomatis and Neisseria gonorrhoeae (TMA) Respiratory DFA with Reflex to Viral Culture (SalmonellaSC2, VibrioAdenovirus, ShigellaRespiratory Syncytial Virus, ListeriaInfluenza A, CampylobacterInfluenza B, E.coli (STECand EIEC)Parainfluenza 1,2, CRE, C. auris& 3) Respiratory Virus Panel SEROLOGY Mumps (PCR) + Measles (IgG) + Measles Virus (PCR) + SARS-CoV-2(IgG) + PCR)+ Middle East Respiratory Syndrome (MERS-CoV)(PCRCoV) + (PCR)+ Xxxx Aptima assay (Xxxx NAAT) (TMA) SEROLOGY CRE Surveillance (PCR) Measles Virus (IgG)+ Flu SC2 Surveillance (PCR) SARSCOV2 (IgG)+ Gonococcal Isolate Surveillance Project (GISP) TOXICOLOGY Xxxx Virus Assay Aptima assay (NAAT)(TMAXxxx NAAT) (TMA) Drug of Abuse Screening Panel (14 drug panel) § Flu/SC2 Surveillance OTHER TESTS Test Name (PCR) OTHER TEST Direct Referral (for testing not conducted at DC PHL) Please specify test name: + DC Health must approve testing prior to sending any isolate or specimen to the DC Public Health Laboratory. § Call the DC Public Health Laboratory prior to sending any specimens. This section is for DC PHL use only Approved/Reviewed by: Printed Name and Title Active Deactivated Signature Date Date Deactivated: Forensic Science Laboratory | Public Health Laboratory | Crime Scene Sciences 000 X Xxxxxx XX, Xxxxxxxxxx, XX 00000specify):
Appears in 1 contract
Samples: dfs.dc.gov
User Responsibility. As a user of the site, you are responsible for the content, material, and information you enter into the system. Your use of the site is limited based on your user access. You are not authorized to access, use, or disclose any content, material or information in the site that is not related to samples that you or your organization have submitted for testing. You are responsible for ensuring that access to patient and testing information through LabOnline is only provided to authorized medical personnel. You are responsible for ensuring that LabOnline is being used properly by your facility’s users. You will communicate any employment status changes or any adjustments to user accounts needed to DC PHL. The facility must review user access to LabOnline every 30 days. Unauthorized access, use, or disclosure of any content, material or information in the site can result in termination of your access to the site and referral to appropriate authorities. Your password is also your responsibility. It is always important to keep your password confidential. If you forget your username or password, please use the “forgot password” feature on the site or contact us at XXX-XxxXxxxxx@xx.xxx. The DC PHL reserves the right to change or replace these Terms of Use or to impose new conditions on the use of the site in which case it will post the revised Terms of Use and update the revision date to reflect the effective date of the changes. The DC PHL reserves the right to deny access to the site or any features of the site to anyone who violates these Terms of Use. I have read the above LabOnline user agreement and agree to adhere to these requirements. By accepting the Terms of Use, I represent and agree: (i) that I am 18 years of age or older, (ii) to comply with these Terms, all applicable laws and regulations, (iii) to use the Site in accordance with these Terms, the Privacy Notice, and any additional term referenced herein; and (iv) that any content, material or information I submit through the Site will not violate the rights of, or cause injury to, any person or entity. User Printed Name and Title User Signature Date Forensic Science Laboratory | Public Health Laboratory | Crime Scene Sciences 000 X Xxxxxx XX, Xxxxxxxxxx, XX 00000 Last Updated: 03/04/2022 District of Columbia ● Department of Forensic Sciences ● Public Health Laboratory 000 X Xxxxxx XX ● 4th Floor ●Washington, DC 20024 ● Phone (000) 000-0000 ● Fax (000) 000-0000 LabOnline Request Form CLIA Laboratory Director: Xxxxxxx X. Xxxxxx, Ph.D., D(ABMM), MLS(ASCP)CM CLIA#: 09D0968273 Type of LabOnline 12/01/2020 Facility Access Requested *Required Information Would you like to request a virtual LabOnline training for your facility? * Yes No LabOnline Access Type* Partial access- Test Ordering ONLY Full access- Test Ordering and Result/Report Access Partial access- Test Ordering ONLY Submitter Information Name of Submitting Hospital, Laboratory, or other Facility* HealthCare Provider NPI #* Health Care Provider* Last Name* First Name* Primary Person of Contact* Last name: First Name: Address* City* State* Zip* Facility Health Care Provider Last and First Name* Facility Health Care Provider NPI Telephone #* User Last and First Name* User Telephone Number* User (primary) Secure Fax Number#* User Secure Email* Testing- please select the test(s) clinical testing that your facility expects to be requesting from sending to DC PHL MICROBIOLOGY/GENERAL BACTERIOLOGY MOLECULAR/VIROLOGY MOLECULAR OCME COVID-19 (NAAT) Gonococcal Isolate Surveillance (GISP) Referred Isolates Novel Influenza (PCR) + Referred Isolates PCR)+ VIRAL CULTURE Chlamydia trachomatis/trachomatis and Neisseria gonorrhoeae (TMA) Respiratory DFA with Reflex to Viral Culture (SalmonellaSC2, VibrioAdenovirus, ShigellaRespiratory Syncytial Virus, ListeriaInfluenza A, CampylobacterInfluenza B, E.coli (STECand EIEC)Parainfluenza 1,2, CRE, C. auris& 3) Respiratory Virus Panel SEROLOGY Mumps (PCR) + Measles (IgG) + Measles Virus (PCR) + SARS-CoV-2(IgG) + PCR)+ Middle East Respiratory Syndrome (MERS-CoV)(PCRCoV) + (PCR)+ Xxxx Aptima assay (Xxxx NAAT) (TMA) SEROLOGY CRE Surveillance (PCR) Measles Virus (IgG)+ Flu SC2 Surveillance (PCR) SARSCOV2 (IgG)+ Gonococcal Isolate Surveillance Project (GISP) TOXICOLOGY Xxxx Virus Assay Aptima assay (NAAT)(TMAXxxx NAAT) (TMA) Drug of Abuse Screening Panel (14 drug panel) § Flu/SC2 Surveillance OTHER TESTS Test Name (PCR) OTHER TEST Direct Referral (for testing not conducted at DC PHL) Please specify test name: specify): + DC Health must approve testing prior to sending any isolate or specimen to the DC Public Health Laboratory. § Call the DC Public Health Laboratory prior to sending any specimensspecimen. This section is for DC PHL use only Approved/Reviewed by: Printed Name and Title Active Deactivated Signature Date Date Deactivated: Forensic Science Laboratory | Public Health Laboratory | Crime Scene Sciences 000 X Xxxxxx XX, Xxxxxxxxxx, XX 00000
Appears in 1 contract
Samples: dfs.dc.gov
User Responsibility. As a user of the site, you are responsible for the content, material, and information you enter into the system. Your use of the site is limited based on your user access. You are not authorized to access, use, or disclose any content, material or information in the site that is not related to samples that you or your organization have submitted for testing. You are responsible for ensuring that access to patient and testing information through LabOnline is only provided to authorized medical personnel. You are responsible for ensuring that LabOnline is being used properly by your facility’s users. You will communicate any employment status changes or any adjustments to user accounts needed to DC PHL. The facility must review user access to LabOnline every 30 days. Unauthorized access, use, or disclosure of any content, material or information in the site can result in termination of your access to the site and referral to appropriate authorities. Your password is also your responsibility. It is always important to keep your password confidential. If you forget your username or password, please use the “forgot password” feature on the site or contact us at XXX-XxxXxxxxx@xx.xxx. The DC PHL reserves the right to change or replace these Terms of Use or to impose new conditions on the use of the site in which case it will post the revised Terms of Use and update the revision date to reflect the effective date of the changes. The DC PHL reserves the right to deny access to the site or any features of the site to anyone who violates these Terms of Use. I have read the above LabOnline user agreement and agree to adhere to these requirements. By accepting the Terms of Use, I represent and agree: (i) that I am 18 years of age or older, (ii) to comply with these Terms, all applicable laws and regulations, (iii) to use the Site in accordance with these Terms, the Privacy Notice, and any additional term referenced herein; and (iv) that any content, material or information I submit through the Site will not violate the rights of, or cause injury to, any person or entity. User Printed Name and Title User Signature Date Forensic Science Laboratory | Public Health Laboratory | Crime Scene Sciences 000 X Xxxxxx XX, Xxxxxxxxxx, XX 00000 Last Updated: 03/04/2022 District of Columbia ● Department of Forensic Sciences ● Public Health Laboratory 000 X Xxxxxx XX ● 4th Floor ●Washington, DC 20024 ● Phone (000) 000-0000 ● Fax (000) 000-0000 LabOnline Request Form CLIA Laboratory Director: Xxxxxxx X. XxxxxxXxxxx Xxxxxxxxxx, Ph.D., D(ABMM), MLS(ASCP)CM ) CLIA#: 09D0968273 Type of LabOnline Facility Access Requested *Required Information Full access- Test Ordering and Result/Report Access Partial access- Test Ordering ONLY Submitter Information Name of Submitting Hospital, Laboratory, or other Facility* Address* City* State* Zip* Facility Health Care Provider Last and First Name* Facility Health Care Provider NPI #* User Last and First Name* User Telephone Number* User Secure Fax Number* User Secure Email* Testing- please select the test(s) that your facility expects to be requesting from DC PHL MICROBIOLOGY/GENERAL BACTERIOLOGY MOLECULAR/VIROLOGY OCME COVID-19 (NAAT) Gonococcal Isolate Surveillance (GISP) Novel Influenza (PCR) + Referred Isolates Chlamydia trachomatis/Neisseria gonorrhoeae (TMA) (Salmonella, Vibrio, Shigella, Listeria, Campylobacter, E.coli (STECand EIEC), CRE, C. auris) Respiratory Virus Panel SEROLOGY Mumps (PCR) + Measles (IgG) + Measles Virus (PCR) + SARS-CoV-2(IgG) + Middle East Respiratory Syndrome (MERS-CoV)(PCR) + TOXICOLOGY Xxxx Virus Assay (NAAT)(TMA) Drug of Abuse Screening Panel (14 drug panel) § Flu/SC2 Surveillance (PCR) OTHER TEST Direct Referral (for testing not conducted at DC PHL) Please specify test name: + DC Health must approve testing prior to sending any isolate or specimen to the DC Public Health Laboratory. § Call the DC Public Health Laboratory prior to sending any specimens. This section is for DC PHL use only Approved/Reviewed by: Printed Name and Title Active Deactivated Signature Date Date Deactivated: Forensic Science Laboratory | Public Health Laboratory | Crime Scene Sciences 000 X Xxxxxx XX, Xxxxxxxxxx, XX 00000
Appears in 1 contract
Samples: dfs.dc.gov
User Responsibility. As a user of the site, you are responsible for the content, material, and information you enter into the system. Your use of the site is limited based on your user access. You are not authorized to access, use, or disclose any content, material or information in the site that is not related to samples that you or your organization have submitted for testing. You are responsible for ensuring that access to patient and testing information through LabOnline is only provided to authorized medical personnel. You are responsible for ensuring that LabOnline is being used properly by your facility’s users. You will communicate any employment status changes or any adjustments to user accounts needed to DC PHL. The facility must review user access to LabOnline every 30 days. Unauthorized access, use, or disclosure of any content, material or information in the site can result in termination of your access to the site and referral to appropriate authorities. Your password is also your responsibility. It is always important to keep your password confidential. If you forget your username or password, please use the “forgot password” feature on the site or contact us at XXX-XxxXxxxxx@xx.xxx. The DC PHL reserves the right to change or replace these Terms of Use or to impose new conditions on the use of the site in which case it will post the revised Terms of Use and update the revision date to reflect the effective date of the changes. The DC PHL reserves the right to deny access to the site or any features of the site to anyone who violates these Terms of Use. I have read the above LabOnline user agreement and agree to adhere to these requirements. By accepting the Terms of Use, I represent and agree: (i) that I am 18 years of age or older, (ii) to comply with these Terms, all applicable laws and regulations, (iii) to use the Site in accordance with these Terms, the Privacy Notice, and any additional term referenced herein; and (iv) that any content, material or information I submit through the Site will not violate the rights of, or cause injury to, any person or entity. User Printed Name and Title User Signature Date Forensic Science Laboratory | Public Health Laboratory | Crime Scene Sciences 000 X Xxxxxx XX, Xxxxxxxxxx, XX 00000 Last Updated: 03/04/2022 District of Columbia ● Department of Forensic Sciences ● Public Health Laboratory 000 X Xxxxxx XX ● 4th Floor ●Washington, DC 20024 ● Phone (000) 000-0000 ● Fax (000) 000-0000 LabOnline Request Form CLIA Laboratory Director: Xxxxxxx X. Xxxxxx, Ph.D., D(ABMM), MLS(ASCP)CM CLIA#: 09D0968273 Type of LabOnline 1/27/2022 Facility Access Requested *Required Information LabOnline Access Type* Partial access- Test Ordering ONLY Full access- Test Ordering and Result/Report Access Partial access- Test Ordering ONLY Submitter Information Name of Submitting Hospital, Laboratory, or other Facility* Address* City* State* Zip* Facility Health Care Provider Last and First Name* Facility Health Care HealthCare Provider NPI #* User Last and First Name* User Telephone Number#* User Secure Fax Number#* User Secure Email* Testing- please select the test(s) clinical testing that your facility expects to be requesting from sending to DC PHL MICROBIOLOGY/GENERAL BACTERIOLOGY MOLECULAR/VIROLOGY MOLECULAR OCME COVID-19 (NAAT) Gonococcal Isolate Surveillance (GISP) Referred Isolates Novel Influenza (PCR) + Referred Isolates PCR)+ VIRAL CULTURE Chlamydia trachomatis/trachomatis and Neisseria gonorrhoeae (TMA) Respiratory DFA with Reflex to Viral Culture (SalmonellaSC2, VibrioAdenovirus, ShigellaRespiratory Syncytial Virus, ListeriaInfluenza A, CampylobacterInfluenza B, E.coli (STECand EIEC)Parainfluenza 1,2, CRE, C. auris& 3) Respiratory Virus Panel SEROLOGY Mumps (PCR) + Measles (IgG) + Measles Virus (PCR) + SARS-CoV-2(IgG) + PCR)+ Middle East Respiratory Syndrome (MERS-CoV)(PCRCoV) + (PCR)+ Xxxx Aptima assay (Xxxx NAAT) (TMA) SEROLOGY CRE Surveillance (PCR) Measles Virus (IgG)+ Flu SC2 Surveillance (PCR) SARSCOV2 (IgG)+ Gonococcal Isolate Surveillance Project (GISP) TOXICOLOGY Xxxx Virus Assay Aptima assay (NAAT)(TMAXxxx NAAT) (TMA) Drug of Abuse Screening Panel (14 drug panel) § Flu/SC2 Surveillance OTHER TESTS Test Name (PCR) OTHER TEST Direct Referral (for testing not conducted at DC PHL) Please specify test name: specify): + DC Health must approve testing prior to sending any isolate or specimen to the DC Public Health Laboratory. § Call the DC Public Health Laboratory prior to sending any specimensspecimen. This section is for DC PHL use only Approved/Reviewed by: Printed Name and Title Active Deactivated Signature Date Date Deactivated: Forensic Science Laboratory | Public Health Laboratory | Crime Scene Sciences 000 X Xxxxxx XX, Xxxxxxxxxx, XX 00000
Appears in 1 contract
Samples: dfs.dc.gov
