New Jersey Request for Testing of Suspected Pathogens of Public Health Significance and Chain of Cus

Form Template

In order to prevent disease outbreaks, the health department carefully tracks reported cases of foodborne illness or environmental toxins to identify suspect agents.

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Health departments will request for lab testing for a suspect sample in order to isolate the pathogen in prevent further infection. With the New Jersey Request for Testing of Suspected Pathogens of Public Health Significance and Chain of Custody app, health departments can document a suspect clinical specimen or environmental sample and request for lab testing. The submitter will complete details about the requesting agency, specimen information, and describe the suspected agent including the type of agents such as bacteria, parasite, or toxin, and the sample description. The applicant will document known information about the patient infected by the pathogen, disease symptoms, travel destinations, and health complications. The submitter will also use a checklist to classify biochemical information about the sample. The app includes an additional chain of custody for signatures by health officials, if applicable. This app is an essential part of a disease control and prevention program in order to communicate details of infectious disease cases, identify a suspect sample, and protect public health from disease-inducing pathogens.

Features
  • Signature Capture
  • Conditional Fields
  • Submission Editing
  • Reference Data
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Platforms
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