Chain of Custody Form for Public Health Laboratory
This document serves as the official chain of custody form used by the Los Angeles County Public Health Laboratory. It includes details about the sample custody process and must be filled out correctly. Ensure to follow the instructions carefully to maintain the integrity of the specimens.
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How do I fill this out?
To fill out this form, start by entering your name and contact information in the designated fields. Next, input the contents of the package being tracked, including any relevant details. Finally, ensure all required signatures are collected to complete the chain of custody.

How to fill out the Chain of Custody Form for Public Health Laboratory?
1
Enter your name and title in the designated fields.
2
Fill in the contact telephone and address for the originator.
3
Detail the contents being released in the form provided.
4
Collect all necessary signatures from each individual involved.
5
Ensure the form is dated properly for record-keeping.
Who needs the Chain of Custody Form for Public Health Laboratory?
1
Laboratory technicians who need a reliable method for tracking specimens.
2
Public health officials who require documentation for legal compliance.
3
Researchers involved in studies that utilize biological samples.
4
Clinics or hospitals that need to provide samples for testing.
5
Regulatory agencies monitoring health and safety standards.
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What are the important dates for this form in 2024 and 2025?
Important dates for the Chain of Custody Form include the submission deadlines for various health inspections and audits occurring in 2024 and 2025. Familiarizing yourself with these dates ensures timely compliance. Always verify with the current public health guidelines for any changes to the schedule.

What is the purpose of this form?
The Chain of Custody Form is crucial for maintaining the integrity of specimen transfer in public health laboratories. It serves to document the handling and movement of samples from one party to another, ensuring accountability and traceability. This form plays a significant role in legal compliance and regulatory inspections.

Tell me about this form and its components and fields line-by-line.

- 1. Originator Name and Title: Field for the name and position of the person releasing the sample.
- 2. Contact Telephone: The telephone number for the originator for any follow-up.
- 3. Contents: Description of the sample or package being transferred.
- 4. Released by Signature: Signature of the individual releasing the sample.
- 5. Received By Signature: Signature of the individual receiving the sample.
What happens if I fail to submit this form?
Failing to submit this form can lead to legal complications and hinder the flow of essential public health reporting. Missing submissions may lead to samples being untracked or improperly documented, risking the integrity of the testing process.
- Legal Compliance: Incomplete submissions may cause issues with regulatory compliance and lead to penalties.
- Sample Integrity: Without proper documentation, the integrity of samples could be questioned.
- Delay in Testing: Organizations may experience delays in the processing of essential health tests due to missing documentation.
How do I know when to use this form?

- 1. Laboratory Transfers: When transferring samples between laboratories.
- 2. Research Studies: For documenting samples used in medical studies.
- 3. Routine Health Inspections: During scheduled health audits to verify sample handling.
Frequently Asked Questions
What is the purpose of this chain of custody form?
This form ensures proper documentation of samples being transferred and provides a reliable tracking method.
Can I edit this PDF online?
Yes, you can edit the PDF directly using the PrintFriendly editor before downloading.
How do I submit this form once completed?
You can submit the form via fax, email, or physical mail as specified in the instructions.
Is there a way to track the status of my submission?
While PrintFriendly does not offer tracking, keeping a copy of your submission for your records is recommended.
Can multiple people sign this form?
Yes, each individual involved can sign in their respective fields.
What information is required to fill out this form?
You need to provide your name, contact details, sample contents, and necessary signatures.
Is there a limit on the number of samples I can document?
No, as long as you provide accurate information for each sample.
Can this form be used for all types of specimens?
Yes, it is designed to accommodate various types of biological samples.
What if I make a mistake while filling out the PDF?
You can easily go back and edit any section of the form before finalizing it.
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