1. Department of State Health Services
3/28/2017
Department of State Health Services
Laboratory Services Section
Biochemistry & Genetics Branch
Clinical Chemistry Laboratory
Slide 1:
Introduce yourself.
Introduce the laboratory.
Today’s presentation will feature the:
Texas Department of State Health Services, Laboratory Services Section, Clinical Chemistry Laboratory.
This presentation will focus on The Texas Department of State Health Services laboratory services provided for the THSteps and Title V Program.

2. DSHS Laboratory Services THSteps and Title V Program
3/28/2017
DSHS Laboratory Services THSteps and Title V Program
Specimen Collection and Shipping/Mailing Supplies
Test results to service providers
Telephone consultations
Slide 2:
We are a full service laboratory. The laboratory not only provides supplies but performs testing and reports test results in a timely manner.
DSHS Laboratory Services provides:
Specimen Collection and Shipping/Mailing Supplies along with instructions for collecting and shipping/mailing specimens.
Test results to service providers
Specimens received daily are given laboratory designations, analyzed, and reported in
approximately 2-3 working days. Upon completion of laboratory analysis, reports are
mailed back to submitters.
Telephone consultations
Explanation of test results
Tips on blood collection
We will focus on:
Individual tests and what they mean
How to get supplies from DSHS laboratory
How to submit specimens
Update on new specimen acceptability criteria

3. DSHS Laboratory Tests Newborn Screening Total Hemoglobin
3/28/2017
DSHS Laboratory Tests
Newborn Screening
Total Hemoglobin
Lead Screening
Hemoglobinopathy Testing
RPR Screening and Confirmation
Cholesterol/Lipid Profile/Glucose/Triple Screen
Hemolytic Disease of the Newborn
Gonorrhea/Chlamydia Infection Screen
HIV Screen
Pap Screen
Slide 3:
The laboratory performs the following tests:
Newborn Screening
Total Hgb
Pb Screening
Hemoglobinopathy Testing (Types)
RPR-syphilis
Other tests performed include:
Lipid Profile, Cholesterol, Glucose, and Triple Screen
Hemolytic Disease of the Newborn
Gonorrhea/Chlamydia Infection Screen
HIV Screen
Pap Screen

4. 3/28/2017
Newborn Screening
Testing for five possible disorders in newborns at birth and days after birth
Congenital Adrenal Hyperplasia (CAH)
Phenylketonuria – (PKU)
Galactosemia
Hemoglobinopathy
Congenital Hypothyroidism
Slide 4:
First test we will begin with is Newborn Screening.
It is Texas State Law to screen all newborns for:
Congenital Adrenal Hyperplasia (CAH)
Phenylketonuria (PKU)
Galactosemia
Hemoglobinopathy Testing
Hypothyroidism
All infants must be tested a second 1-2 weeks of age. If there is any doubt that a child under 12 months of age was properly tested, the provider should submit a blood specimen on the appropriate TDSHS blood collection form (filter paper) NBS-3 to the DSHS lab.
Supervisor for the NBS program is Lynette Borgfeld.

5. Newborn Screening (NBS-3) Form
3/28/2017
Newborn Screening (NBS-3) Form
Slide 5:
Discuss Newborn Screening(NBS) collection forms NBS 4 and NBS 3:
Newborn Screening collection form includes an instruction sheet that is torn away, a demographic form that is to be filled out and a filter paper portion where the blood specimen is collected.
Collection instructions are attached.
Show where the filter paper portion is and where blood is collected on the form.
With the collection instructions removed there is a demographic entry portion of the form which is basically computer blocks, and each of these blocks must be filled in with legible capital letters in black ink or black pencil.
Each form has a serial number and each serial number is usually bar coded in one portion of the form and also listed on the end of the form and on the filter paper as well, in case they get separated. In fact, they will get separated in the laboratory.
There is a portion of the form which is specific for your identification label. This label is different from the one that you use in the THSteps Program. It is the label which you would receive from the laboratory in Austin, the NBS Program, and it has a NBS identifying number which is different from your THSteps number. If you don’t have one of these numbers please contact the laboratory and we will provide one for you.
The most important part of the NBS specimen collection is collection of the specimen on filter paper. There are five circles that are dashed and numbered and also the backside of the filter paper is marked identically.
Avoid using capillaries, they tend to be laced with EDTA. EDTA interferes with NBS testing.
Pay attention to expiration dates on forms you receive, especially the filter paper area. The laboratory will not except specimens collected on expired forms. The laboratory will report the specimen as unsatisfactory for testing due to expired form.
The laboratory will not test specimens if:
Date of collection is not provided
Form is expired
Specimen is too old to test; older than 13 days from time of collection.

6. Newborn Screening (cont.)
3/28/2017
Newborn Screening (cont.)
Filter paper collection
Wall Chart- collection technique
Reference chart – Valid specimen
Newborn Screening Program – “Guide to Practitioners”
Slide 6:
When calling the laboratory/NBS program for questions about NBS tests, please refer to “Newborn Screening”, not PKUs.
PKU is a disorder and the program performs tests other than PKU.
Wall chart – We have for your offices a wall hanging chart you can place on the wall to show your staff how to collect a specimen properly. This is available from the laboratory.
S&S charts- We also have another chart showing what poor specimen collection looks like. This is something that your staff will need to focus on to determine if they are collecting a specimen properly or not.
NBS program has a “A Practitioners Guide” and it is available through the Program. It talks about:
Role of Physician
Interpretation of some of the test results.
In addition, there are a different number of different types of handout materials available for parents and/or physicians who want to understand more about a specific test and most are available in English and Spanish.
How do you get NBS supplies?
Orders for NBS supplies and collection forms are handled different from the orders for
THSteps and Title V supplies. A written request for NBS specimen collection form NBS-3 and NBS
supplies is required. To obtain an order form for written requests call: (512) or ext. 7661

7. Total Hemoglobin Testing for evidence of anemia
3/28/2017
Total Hemoglobin
Testing for evidence of anemia
Required 6, 12, and 24 months and 6, 12 and 16 years of age
Laboratory procedure:
SLS-Hb (sodium lauryl sulfate –
metthemoglobin method)
Sysmex XT-1800i/KX-21N/pocHi
Normal Range: g/dL
Slide 7:
The Laboratory analyzes approximately 1500 specimens/day.
When the laboratory finds critical values we call the provider within one hour of confirmation of a critical abnormal test results.
A critical value is < 7g/dL.
Instrumentation used: XT-1800i and KX-21N
Hematocrit is not performed because of the age of the specimens. (cell degradation)

8. 3/28/2017
Sysmex KX-21N
Slide 8:
Picture of Letricia working on the KX-21N.
There are 4 - KX-21Ns and 1 - XT-1800i in the laboratory.

9. 3/28/2017
Sysmex XT-1800i
Slide 9:
Picture of Victor working on the Sysmex XT-1800i automated system.

10. Lead Screening Testing for possible lead intoxication
3/28/2017
Lead Screening
Testing for possible lead intoxication
Blood Lead screening required 12 and 24 months.
Lead questionnaire required at 6 and 18 months, and at 3, 4, 5, and 6 years of age.
Laboratory procedure
Blood Lead (Pb)
Atomic Absorption Spectrophotometer
Graphite Furnace (PE AA600/4100ZL)
Expected Results
Pb < 10 μg/dL
Slide 10:
State mandate to test for lead exposure.
On the lead questionnaire, a yes to any of the questions requires a test for blood lead. This information is shown in your Texas Medicaid Provider Procedures Manual (TMPPM) and if you do not have one you can get one from TMHP or THSteps office.
For lead test results of μg/dL, there are follow up guidelines found in your (TMPPM).
Lead results > 15 μg/dL obtained from a fingerstick collected specimen should be resubmitted in a venous tube.
Techniques used in the laboratory are so precise and go to such low levels that the slightest contamination can give a false positive. However, the laboratory follows certain protocol to follow up on false positives.
Results reported (10 – 24) μg/dL provider monitors these children. Again,there are follow up guidelines in your Provider Procedure Manual that explains what needs to be done.
A test result for lead equal to and greater than 40 μg/dL is a critical value and we call the provider to report this critical value within one hour of confirmation.

11. PE AA600 3/28/2017 Slide 11: A picture of an AA600.
We have 9 atomic absorption spectrophotometers in the laboratory;
Three 4100ZLs and six 600s.

12. 3/28/2017
Hemoglobinopathy
Testing for sickle cell diseases and other hemoglobin disorders
Required at birth and days after birth
Laboratory procedure
Isoelectric Focusing (IEF)
Citrate Agar Electrophoresis
Normal Result: A,A (homozygous)
Hemoglobin F may be present in children under 1 year of age.
Slide 12:
Follow slide.
In this testing Program at birth, it is part of the NBS Program. (bullet #2)
Not only do we pick up sickle cell anemia (S,S), we also pick up sickle cell trait and other abnormal variants. i.e. D, C, E, and G, etc.
If we report back to you an A,S that means we saw on our test half adult hemoglobin and half sickle cell hemoglobin and that would appear to us as sickle cell carrier. If you know that this patient was a sickle cell anemic patient who recently had a transfusion this would explain why the test showed up as an A,S. You have the history of the patient and the laboratory provides you with the result. Your responsibility is to couple the two in your diagnosis. Be careful with that.
Citrate agar test is coupled with IEF for confirmation whenever an abnormal variant is found.
It is important to remember to provide us with the Date of Birth. When requesting this test make sure the correct date of birth is written on the request form for the lab to accurately report a result.
The laboratory has been successful in detecting hemoglobin A1C which has a significant correlation with diabetes. When the laboratory detects an A1C we call the provider.
Hemoglobin type by electrophoresis should be requested if it is not part of the child’s medical record. It may also be done at the discretion of the provider.

13. Isoelectric Focusing Electrophoresis
3/28/2017
Isoelectric Focusing Electrophoresis
Slide 13:
Picture of Ileana setting up an IEF gel on an Isoelectric Focusing chamber.

14. Rapid Plasma Reagin (RPR)
3/28/2017
Rapid Plasma Reagin (RPR)
Testing for presence of syphilis
Optional – no longer required
Laboratory procedure
18 mm RPR card test
Normal result
non-reactive
Any (+) RPR is submitted for confirmation
Slide 14:
RPR is a card test to detect reagin, not a test for Treponemal, which is the causative agent for syphilis. Reagin is present in serums/plasma from syphilitic persons.
False (+) can occur with other acute/chronic conditions i.e. infectious mononucleosis, leprosy, malaria, even birth control pills.
If a serum specimen is found to be positive for syphilis the submitter will be notified that the patient’s specimen will need to be recollected and submitted with a G-2A form for a confirmatory test. Specimen can be submitted at ambient temperature so long the specimen is tested within 5 days.
A confirmed (+) test is reported to the Local Health Department.

15. 3/28/2017
RPR Card Test
Slide 15: Picture of RPR card test with specimens in the circles where we are looking for agglutination.

16. Glucose Testing Testing for high levels of blood glucose.
3/28/2017
Testing for high levels of blood glucose.
Laboratory procedure:
-Enzymatic measure by automated chemistry analyzer.
Beckman Synchron CX4
Desired Results: Random mg/dL
1-Hr GTT < 140mg/dL
2-Hr PP < 120 mg/dL
3-HR GTT:
Fasting < 105 mg/dL
1-HR < 190 mg/dL
2-HR < 165 mg/dL
3-HR < 145 mg/dL
Slide 16:

17. Cholesterol Screen & Lipid Profile
3/28/2017
Cholesterol Screen & Lipid Profile
Testing for potential development of coronary heart disease
Blood Cholesterol Screen
Children over 2 years of age:
-with a parent having a cholesterol > 240 mg/dL
-with multiple risk factors (smoking, obesity,
hypertension, diabetes, fatty diet)
Lipid Profile
Test is done only for children over 2 years of age in
high risk category. (Family history of heart or
vascular disease)
Slide 17:
This test is performed when a child over 2 years of age:
has a parent that has a cholesterol > 240 mg/dL or
has multiple risk factors and is at risk at any time based on assessment then he/she will be screened for cholesterol.
Another way to perform a cholesterol test is by Lipid Profile.
-A cholesterol test is included in/part of the lipid profile. This test should be performed on a patient that is fasting.

18. Cholesterol & Lipid Profile (cont.)
3/28/2017
Cholesterol & Lipid Profile (cont.)
Laboratory procedure:
Enzymatic measure by automated chemistry analyzer. Beckman Synchron CX4
Desired Results: Cholesterol < 170 mg/dL
Triglycerides 30 – 190 mg/dL
HDL > 35 mg/dL
LDL < 110 mg/dL
Slide 18:
Follow slide.

19. 3/28/2017
Beckman CX4
Slide 19:
Picture of Liz with the Beckman CX-4 chemistry analyzer.

20. Hemolytic Disease of the Newborn (HDN Testing)
3/28/2017
Testing for blood type (ABO) and Rh factor.
Antibody Screen
Performed to detect and titer clinically significant antibodies
Antibody Identification
Antibody titer
Immucor Capture Solid Phase
Slide 20:
Specimens must be shipped overnithreceived cold if testing will not be performed in 24 hours.

21. Immucor Capture Solid Phase
3/28/2017
Immucor Capture Solid Phase
Slide 21: Picture of Lisa reading a ABO blood types on mictrotiter plates.

22. Triple Screen Testing Testing for birth defects:
3/28/2017
Testing for birth defects:
Down’s Syndrome,
Open Neural Tube Defects – (Open Spina Bifida),
Trisomy 18
Biochemical Tests include:
hCG - human chorionic gonadotropin
AFP – alpha-fetoprotein
uE3- unconjugated estriol
All three are used for determining risk for Trisomy 18 and 21, while AFP alone is used to determine NTD risk.
Performed during weeks and 6 days of gestation.
Beckman Coulter - AccessII
Slide 22:
Triple screen test is offered to expectant mothers during the weeks and 6days of gestation.
For the screening, a sample of blood is drawn from the mother to measure the levels of:
hCG (human chorionic gonadotropin)
estriol, which are produced by the placenta, and the level of
alpha-fetoprotein (AFP), which is produced by the fetus.
The levels of these three substances in the blood can help doctors identify a fetus at risk for certain birth defects such as Trisomy18 and 21, Open Neural Tube defects and other chromosomal abnormalities like Down syndrome.

23. Beckman Coulter Access II
3/28/2017
Beckman Coulter Access II
Slide 23: Terri holding an autosampler sector for the Beckman Coulter AccessII.

24. Triple Screen Testing (cont.)
3/28/2017
Triple Screen Testing (cont.)
Factors used in the calculation of patient risks:
Gestational age is determined by physical exam, dating of last menstrual period, and/or ultrasound dating.
Maternal age
Maternal weight
Maternal non-gestational insulin-dependent diabetic status
Maternal race
Number of fetuses
Slide 24: Must have this information to interpret test results appropriately.

25. Recalculation of Triple Screen Test Results
3/28/2017
Recalculation of Triple Screen Test Results
Fax request for recalculation using Request for Recalculation of Prenatal Screening report to
Recalculation of Prenatal Triple screen will be performed based on a change in the gestational age only if the change is 10 days or more.
Slide 25:
To request a Recalculation of Triple Screen test results:
Fax request for recalculation using Request for Recalculation of Prenatal Screening report to There is a copy in your packet.
Recalculation of triple screen test results will be performed based on a change in the gestational age only if the change is 10 days or more.

26. Gonorrhea/Chlamydia Screen
3/28/2017
Gonorrhea/Chlamydia Screen
Testing for presence of infection by Neiserria gonorrhoeae and Chlamydia trachomatis
Physician’s discretion
Laboratory procedure
DNA probe technology
Normal Result: Negative
Slide 26:
Part of the Adolescent Program is:
Gonorrhea/Chlamydia Screen – usually for sexually active adolescents between the ages of
A swab sample is recommended (for both female and male) instead of urine.
Urine limits testing to only chlamydia and also dilutes the organism.
Highly recommend that this screen is not used for medical legal issues.
Submit specimen with G-2B submission form.
Note:
Follow slide.
For any questions related to this test contact Clinical Bacteriology (512)

27. HIV Screen Testing for presence of human immunodeficiency virus
3/28/2017
HIV Screen
Testing for presence of human immunodeficiency virus
Adolescents at risk for HIV infection – CONSENT for confidential screening
Include pre- and post test counseling
Laboratory procedure
Enzymatic Immunoassay (EIA)
Western Blot
Normal Result: Negative
Slide 27:
Another part of the Adolescent Program is:
HIV Screen - follow slide.
Western blot is done on (+) tests found.
Submit specimen collected in a red top or tiger top tube with a G-2A form.
Important thing to remember is that you certainly need to have pre and post counseling.
For any questions related to this test contact HIV/STD Serology (512)

28. 3/28/2017
Pap Screen
Testing for the detection of malignant, premalignant, and infectious disease of the uterine cervix.
Laboratory procedure
Pap stain technique
Normal Result
Negative
Specimens must be sent to DSHS Women’s Health Laboratories in San Antonio.
(210) or Toll-free:
Slide 28:
Follow slide.
Submit specimen with M-47 form to Women’s Health Laboratory in San Antonio Texas.
For any questions related to any of these laboratory tests, there are discussions in your Medicaid Provider Procedure Manual which also contains the THSteps medical checkup periodicity schedule and follow up guidelines.

29. Collection and Shipping Supplies
3/28/2017
Collection and Shipping Supplies
Supplies for Collection and Shipping of Specimens
Do’s and Don’ts of Specimen Collection
Submission of Specimens
Forms G-1B, G-2A, G-2B, and M-47
Slide 29:
How do you get laboratory supplies?
It’s important to establish your client rate and order supplies from us on a quarterly basis or semi-annual basis. The reason for this is that we don’t want those supplies to sit on shelves and expire.
Each THSteps Starter Kit contains:
Purple top tubes (venous and capillary) with instruction sheet.
Red top tubes
Safety lancets (BD genie 2.0 mm depth 1.5 mm gauge (width))
Collection needles (22 gauge 1 inch multi- draw Vacutainer® needle)
Safety needle holder
G-399 form
Small and medium mailing containers, mailing labels
Instruction sheet for sample collection guidelines and instruction sheet for specimen submission, instruction poster for “Packing Blood Tubes for Shipment”, and a page of useful phone numbers.
Blood lead book “Get the Lead Out” and other pamphlets.
For the Title V children’s program the DSHS will provide all the supplies needed for specimen collection with the exception of the postage paid labels. For the adult program the laboratory provides the gray tops but not red tops. Red tops are obtained through the DSHS pharmacy.
The DSHS laboratory does not provide the lancets for NBS specimen collection.

30. Tips for Successful Submission of Specimens
3/28/2017
Fill out test request forms accurately and completely.
Patient name on specimen must match name on test request form.
Purple top blood collection tubes should be filled according to manufacturer package insert.
Thoroughly mix blood collected in purple top tubes immediately after collection to avoid specimen from clotting.
Avoid lead contamination from skin when collecting blood specimen for lead testing by washing the puncture site with soap and water.
Slide 30:
“Do’s and Don’ts of Specimen Collection” are important for successfully submitting specimens.
When collecting specimens from THSteps patients you will need to submit a separate tube and form for each test requested because there are special shipping requirements for some of the tests such as the tests for the cholesterol/lipid profile, glucose, and triple screen testing.
Examples: For total hemoglobin, lead, hemoglobin type, and RPR test requests submit one purple top tube for total hemoglobin, lead, and hemoglobin type testing and one red top tube for RPR testing along with one G-1B form unless the RPR is for a confirmatory test. If this is the case, submit the RPR specimen with a G-2A form.
If an RPR, cholesterol/lipid profile, and glucose tests are ordered collect three separate specimens. The RPR and cholesterol/lipid profile are collected in red top tubes and the glucose specimen is collected in a gray top tube. Please send three separate requisition forms for each test.
When using finger stick collection method:
For finger stick collection tubes, legibly write or print the patient’s name on adhesive tape, small address label, medical tape, or masking tape and attach it to the tube. Ensure the label will not come off easily.
Personnel handling supplies involved in finger stick collections must wash hands with soap and water and wear gloves to avoid contaminating the specimen.
Always wipe away the first drop of blood and avoid scraping site of collection, as this can stimulate clotting.
Do not add additional anticoagulant to collection tubes.
Finger stick blood collection tube may be taped/parafilmed to keep speciment from leaking in transit.

31. Tips for Successful Submission of Specimens (cont.)
3/28/2017
Purple top specimens submitted for lead, total hemoglobin, and hemoglobin type may be shipped at ambient temperature and tested 21 days from date of collection.
Do NOT freeze whole blood specimens.
Mail specimens same day of collection.
Pack tubes carefully and ensure they are properly capped to avoid specimen leaking in transit.
Place specimens in PLASTIC canister. Wrap plastic canister with form/s and place in cardboard mailing container.
Tips for Successful Specimen Collection:
Slide 31:
Follow slide.
Drop off specimens at the Post Office vs. drop boxes.

32. Specimen Acceptability Criteria Update
3/28/2017
Specimen Acceptability Criteria Update
Becton Dickinson (BD) Microtainer® 250 uL – 500 uL Tube
Slide 32:
The tube is used for finger/heel sticks. The manufacturer stated fill volume for this tube is in the range of 250 uL minimum to 500 uL maximum. (The arrows point to the 250 uL and 500 uL lines.)
Beginning June 19, 2005 specimens collected in RAM Scientific blood collection tube will be rejected.
Liquid EDTA – potential problem with dilution factor for hematology testing.
Difficult to meet fill volume requirements.

33. Specimen Acceptability Criteria Update
3/28/2017
Specimen Acceptability Criteria Update
Becton-Dickinson (BD) 2mL Vacutainer® K2 EDTA 3.6mg Tube
Slide 33:
The tube is used for venipuncture draws. The manufacturer stated fill volume for this tube is 2 mL. The Vacutainer® should draw the tube’s fill volume automatically. The black mark on the label of the tube (indicated by the arrow) is an estimated volume mark, not an actual volume mark. The position of the label varies from tube to tube. The 2 mL Vacutainer® will draw blood from the vein at a much slower rate than the higher volume Vacutainer® tubes which is appropriate when collecting blood specimens from pediatric patients.
"Butterfly" collection systems are not recommended because the blood collection tubes may lose vacuum due to dead space in the tubing and may affect fill volume requirements and cause quantity insufficient, even clotting.
However, we have found in speaking to several providers that this is a technique that is the most helpful in obtaining the appropriate volume. The idea is to take a syringe large enough to hold the volume needed depending on how many specimens the submitter plans to submit and attach it to the butterfly tubing. The blood can then be drawn into the syringe.
The amount of blood is now measurable and the person collecting the specimen can ensure the proper volume is being collected into the the blood collection tube.
This techniques is recommended that it be performed within 2 minutes to ensure the specimen does not clot.

34. RPR Specimen Submission and Shipping Instructions
3/28/2017
Whole blood or serum specimens may be submitted at ambient temperature as long as the specimens are received within 5 days from the time of collection.
Day one is the day the specimen is collected, unless the time of collection is documented on the G-1B form. If the time of collection is provided, the five days are calculated from the actual time of collection.
If serum specimens will not arrive at the laboratory within 5 days: Specimens will be accepted if frozen, but must be shipped overnight on dry ice.
Record the date and time specimens are removed from the freezer on the G-1B form.
Do not ship specimens to the DSHS Laboratory on Friday or the day before a Federally observed holiday.
Slide 34:
When submitting whole blood or serum specimen at ambient temperature for RPR testing, please ensure that the date and the time of collection is documented on the G-1B form so the full 5 days are accounted for.
When submitting frozen serum specimens, please ensure the date and time the specimen was removed from the freezer is documented in the box located on the bottom right of the G-1B or form.
Cost for shipment of overnight of RPR specimens on dry ice is the responsibility of the submitter.

35. Cholesterol, Lipid Profile and Glucose Specimen Collection Guidelines
3/28/2017
Cholesterol, Lipid Profile and Glucose Specimen Collection Guidelines
Collect specimens for lipid profile and cholesterol testing in red top tubes.
Serum must be separated from red cells within 2 hours from time of collection and frozen.
Collect specimens for glucose testing in gray top tubes.
Plasma must be separated from red cells within 24 hours from time of collection and frozen.
Slide 35:
The additive in the gray top tube allows the plasma to remain in contact with the red blood cells longer than 2 hours but the plasma must be removed from the red blood cells within 24 hours from time of collection.

36. Cholesterol, Lipid Profile and Glucose Shipping Instructions
3/28/2017
Cholesterol, Lipid Profile and Glucose Shipping Instructions
Record the date and time the specimen was removed from the freezer on each G-1B form.
Package and ship specimens overnight with enough cold packs or dry ice to maintain specimens at proper temperature until arrival at DSHS Laboratory.
Friday or the day before a Federally observed holiday.
Slide 36:
The laboratory provides air bills and shipping supplies needed for the shipping of cholesterol, lipid profile, glucose and triple screen specimens for THSteps and/or Title V providers. If you need supplies for the shipment of these specimens please contact the Container Preparation staff.

37. Cholesterol, Lipid Profile, and Glucose Specimen Packing Diagram
3/28/2017
Cholesterol, Lipid Profile, and Glucose Specimen Packing Diagram
Slide 37:
The diagram above illustrates the proper packing and shipping of cholesterol, lipid profile, and glucose specimens.
Again, glucose specimens should be collected in a gray top tube, centrifuged, and the plasma separated from the red blood cells within 24 hours from the time of collection and frozen until specimens are shipped to the laboratory.
Cholesterol and lipid profile specimens should be collected in a red top tube, centrifuged, and the serum separated from the red blood cells within 2 hours from the time of collection and frozen until specimens are shipped to the laboratory.

38. Triple Screen Specimen Collection and Shipping Guidelines
3/28/2017
Triple Screen Specimen Collection and Shipping Guidelines
Specimens must be collected during the 15–20 week and 6 days of pregnancy.
Collect specimens for triple screen testing in red top tubes.
Serum must be separated from red cells within 2 hours from time of collection and frozen.
Record the date and time the specimen was removed from the freezer on each G-1B form.
Package and ship specimens overnight with enough cold packs or dry ice to maintain specimens at proper temperature until arrival at DSHS Laboratory.
Please do not ship specimens to the DSHS Laboratory on Friday or the day before a Federally observed holiday.
Slide 38:
Make sure the date and time in which the specimens were removed from the freezer is documented on the G-1C form.

39. Triple Screen Specimen Packing Diagram
3/28/2017
Slide 39:
The diagram above illustrates the proper packing and shipping of Prenatal Triple Screen specimens which is very similar to that of cholesterol, and lipid specimens except the request form is the G-1C, not G-1B and the Prenatal triple screen serum specimens are transported in a special blue top tube. The blue top transport tube can be obtained from DSHS laboratory.
Prenatal triple screen specimens should be collected in a red top tube, centrifuged, and the serum separated from the red blood cells within 2 hours from the time of collection and frozen until specimens are shipped to the laboratory.
Since testing must be completed within 48 hours from removal of the freezer, specimens must be shipped overnight and not on Fridays or before federally observed holidays.

40. Hemolytic Disease of the Newborn Specimen Collection and Shipping Guidelines
3/28/2017
Collect specimens for HDN testing in red top tubes.
Ship specimens overnight at ambient temperature
Specimens that cannot be received by DSHS laboratory within 24 hours from time of collection should be stored at 1-10ºC.
Do not freeze specimens.
Package and ship specimens, including enough cold packs to maintain specimens at the proper temperature until arrival at the DSHS Laboratory, if cold shipment is required.
Do not ship specimens to the DSHS Laboratory on Friday or the day before a federally observed holiday.
Slide 40:

41. The G-1B Laboratory Submission Form
3/28/2017
The G-1B Laboratory Submission Form
Master form
An instruction page for filling out the form
Descriptions of the DSHS programs listed on the submission form
Slide 41:
A Master copy of the form will be provided for you.
Instructions for filling out form and submitting lab specimens should come with the master form. Once you receive copies of the master form you may make copies.
Please call us if you do not receive specimen requisition form instructions.

42. Specimen Submission Form G-1B
3/28/2017
Slide 42:
Submitter Information (Section 1):
Verify that your submitter/TPI number (9 digit numeric#) is on the form.
Verify that the most current clinic name, address, phone#, fax#, and contact person are on the form.
The name of the Doctor requesting the test is helpful when there are several docs in a clinic.
Phone, fax, and contact – The laboratory must be able to contact the submitter when more information is needed.
Clinic Code – If a submitter has a primary mailing address with satellite offices, a code can be entered to allow the submitter’s central office to route the results back to the satellite offices. This applies only to THSteps reports.
Patient Information (Section 2):
The patient name on the form must exactly match the name on the specimen submitted to the laboratory and must also match the name on the Medicaid/Medicare card (if applicable), even if the name on the Medicaid card is incorrect.
A copy of the patient’s Medicaid card may be attached to the form.
Pre-printed patient labels used for specimen identification MUST match the patient name on the submission form.
Problems with identification can be avoided by placing a pre-printed patient label on BOTH the specimen and the submission form.
Patient address, city, state, zip, Date of Birth, sex, social security#, and Date of Collection are required for billing Medicaid.
Specimen Type (Section 3):
Indicate what type of specimen is being submitted by checking the boxes.
Clinical Chemistry (Section 4):
▲= For cholesterol, lipid profile, & glucose testing document time & date specimens were removed from FREEZER/ REFRIGERATOR in the lower right-hand box.
♠ = Tests covered by THSteps or Title V Well-Child Health Programs.
Specimens for THSteps must be submitted to DSHS laboratory for proper Medicaid reimbursement.
THSteps providers use when completing a comprehensive medical check-up or Title V is completing a well child visit.
Physician Information (Section 5):
Required if providing Medicare Services. Must provide NPI number.
Payor Source (Section 6):
Ensure accurate billing information is provided otherwise submitter will be billed.
Make sure you indicate who will be billed by checking: Submitter, Medicaid, Medicare, Private Insurance, and/or other.
Designate what type of program you are submitting a specimen for. If THSteps is selected, the patient Medicaid number is required.

43. Specimen Submission Form G-2A
3/28/2017
Specimen Submission Form G-2A
Slide 43:
Submitter Information (Section 1):
Verify that your submitter/TPI number (9 digit numeric#) is on the form.
Verify that the most current clinic name, address, phone#, fax#, and contact person are on the form.
The name of the Doctor requesting the test is helpful when there are several docs in a clinic.
Phone, fax, and contact – The laboratory must be able to contact the submitter when more information is needed.
Clinic Code – If a submitter has a primary mailing address with satellite offices, a code can be entered to allow the submitter’s central office to route the results back to the satellite offices. This applies only to THSteps reports.
Patient Information (Section 2):
The patient name on the form must exactly match the name on the specimen submitted to the laboratory and must also match the name on the Medicaid/Medicare card (if applicable), even if the name on the Medicaid card is incorrect.
A copy of the patient’s Medicaid card may be attached to the form.
Pre-printed patient labels used for specimen identification MUST match the patient name on the submission form.
Problems with identification can be avoided by placing a pre-printed patient label on BOTH the specimen and the submission form.
Patient address, city, state, zip, Date of Birth, sex, social security#, and Date of Collection are required for billing Medicaid.
Specimen Source or Type (Section 3):
Indicate what type of specimen is being submitted by checking the boxes.
Physician Information(Section 4):
Required if providing Medicare Services. Must provide NPI number.
Payor Source (Section 5):
Ensure accurate billing information is provided otherwise submitter will be billed.
Make sure you indicate who will be billed by checking: Submitter, Medicaid, Medicare, Private Insurance, and/or other.
Designate what type of program you are submitting a specimen for. If THSteps is selected, the patient Medicaid number is required.
Reference Serology (Section 6), HIV Screen (Section 7) and Syphilis Serology (Section 8):
♠ = Tests covered by THSteps or Title V Well-Child Health Programs.
♣ = Reflex test(s) will be performed on positive results.
Specimens for THSteps must be submitted to DSHS laboratory for proper Medicaid reimbursement.

44. Specimen Submission Form G-2B
3/28/2017
Specimen Submission Form G-2B
Slide 44:
Submitter Information (Section 1):
Verify that your submitter/TPI number (9 digit numeric#) is on the form.
Verify that the most current clinic name, address, phone#, fax#, and contact person are on the form.
The name of the Doctor requesting the test is helpful when there are several docs in a clinic.
Phone, fax, and contact – The laboratory must be able to contact the submitter when more information is needed.
Clinic Code – If a submitter has a primary mailing address with satellite offices, a code can be entered to allow the submitter’s central office to route the results back to the satellite offices. This applies only to THSteps reports.
Patient Information (Section 2):
The patient name on the form must exactly match the name on the specimen submitted to the laboratory and must also match the name on the Medicaid/Medicare card (if applicable), even if the name on the Medicaid card is incorrect.
A copy of the patient’s Medicaid card may be attached to the form.
Pre-printed patient labels used for specimen identification MUST match the patient name on the submission form.
Problems with identification can be avoided by placing a pre-printed patient label on BOTH the specimen and the submission form.
Patient address, city, state, zip, Date of Birth, sex, social security#, and Date of Collection are required for billing Medicaid.
Specimen Source or Type (Section 3):
Indicate what type of specimen is being submitted by checking the boxes.
Physician Information(Section 4):
Required if providing Medicare Services. Must provide NPI number.
Payor Source (Section 5):
Ensure accurate billing information is provided otherwise submitter will be billed.
Make sure you indicate who will be billed by checking: Submitter, Medicaid, Medicare, Private Insurance, and/or other.
Designate what type of program you are submitting a specimen for. If THSteps is selected, the patient Medicaid number is required.
Bacteriology (Section 6):
♠ = Tests covered by THSteps or Title V Well-Child Health Programs.
Specimens for THSteps must be submitted to DSHS laboratory for proper Medicaid reimbursement.

45. Specimen Submission Form G-1C
3/28/2017
Slide 45:
All information must be completed on the G-1C form for prenatal triple screens.
Submitter Information (Section 1):
Verify that your submitter/TPI number (9 digit numeric#) is on the form.
Verify that the most current clinic name, address, phone#, fax#, and contact person are on the form.
The name of the Doctor requesting the test is helpful when there are several docs in a clinic.
Phone, fax, and contact – The laboratory must be able to contact the submitter when more information is needed.
Clinic Code – If a submitter has a primary mailing address with satellite offices, a code can be entered to allow the submitter’s central office to route the results back to the satellite offices. This applies only to THSteps reports.
Patient Information (Section 2):
The patient name on the form must exactly match the name on the specimen submitted to the laboratory and must also match the name on the Medicaid/Medicare card (if applicable), even if the name on the Medicaid card is incorrect.
A copy of the patient’s Medicaid card may be attached to the form.
Pre-printed patient labels used for specimen identification MUST match the patient name on the submission form.
Problems with identification can be avoided by placing a pre-printed patient label on BOTH the specimen and the submission form.
Patient address, city, state, zip, Date of Birth, sex, social security#, and Date of Collection are required for billing Medicaid.
Triple Screen Request & Patient Information (Section 3):
All information is required for testing.
Physician Information (Section 4):
Required if providing Medicare Services. Must provide NPI number.
Payor Source (Section 5):
Ensure accurate billing information is provided otherwise submitter will be billed.
Make sure you indicate who will be billed by checking: Submitter, Medicaid, Medicare, Private Insurance, and/or other.
Designate what type of program you are submitting a specimen for.

46. Specimen Submission Form M-47
3/28/2017
Specimen Submission Form M-47
Slide 46:
The M-47 form may be obtained from the Women’s Health Laboratory. Call 1(888) Alice Felix is the contact person from the Women’s Health Lab.

47. To Order Master Forms or Change Submitter Information
3/28/2017
To Order Master Forms or Change Submitter Information
Call or
Slide 47:
Eventually you will get to the point where your master copy gets worn out. If you need to order extra forms here is the phone number and address for you to request a master copy of the G-1B, G-2A, G-2B, and/or G-1C form.
This will be an opportunity to update any changes such as change of address, phone numbers, etc.
-OR-

48. Laboratory Services Section Phone Numbers
3/28/2017
Clinical Chemistry Laboratory Specimen Submission
(512) (512)
Newborn Screening Laboratory Billing Information
(512) (512) x3819
Ask for Accounts Receivable Lab Reporting
(512) Test Results Triple ScreenTesting
(512) Newborn Screening
(Voice Response System) (512)
(512) fax (512) fax
Specimen Collection Supplies
(512) THSteps (EPSDT)
(512) Newborn Screening
(512) fax
Slide 48:
Please remember that if you do not receive a report back within about two weeks something probably happened to it because normally in the laboratory it takes 2-3 days from the time we receive the specimen, analyze, and mail a result; depending on mail service both ways, allow an additional 4-6 days. For a total of 10 days.
Specimens have been lost in the mail.
If you do not receive a laboratory report please give us a call.

49. Comments and Questions
3/28/2017
Comments and Questions
Slide 49:
Are there any questions or comments?