Other Streptococci and Catalase-negative, Gram-positive Cocci Testing Request Form

If your isolate is eligible for CDC typing or other characterization, please complete the form below in as much detail as possible. You will hear back from CDC within 5 business days.

Testing Request

(* indicates a required field)

Contact Information:

Name*

Phone Number*

Email Address*

Affiliation* (e.g., state health department, skilled nursing facility, etc. with which you are affiliated)

Impact:

How will isolate testing influence clinical management or public health action?*

Case(s) Description (enter 'N/A' if information unavailable):

Antibiotic susceptibility results (please include all tests and results)*

Epidemiologic information (organism Genus and species, patient’s age group, culture date, epidemiologic link between multiple cases, resident of skilled nursing facility, etc.)*

Sterile site from which isolate(s) was obtained (for examples of sterile sites, see the ABCs Case Definition page)*

Underlying condition(s) or risk factors present*
Yes No

If yes, please specify

Any other pertinent information

Security Question:*
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You can send additional questions to pneumococcus@cdc.gov.

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Frequently Asked Questions about Contacting CDC’s Streptococcus Laboratory