Mycobacterium tuberculosis Drug Susceptibility and NTM Testing Performance Evaluation Enrollment Form

CDC en Español

MPEP Content

	MPEP Home

	Laboratory Quality Assurance

	Program Description

	Enrollment Forms

	Shipment Schedule

	MPEP Privacy Policy

	Publications

	Presentations

	Contact Us


Current Programs

	HIV-1 Rapid

	Tb Drug Susceptibility


Previous Programs

	HIV Viral Load

	HIV-1 Antibody

	HTLV I/II Antibody

	HIV-1 p24 Antigen

	HIV-1 RNA

	TLI (CD4 Testing)

	Tb Nucleic Acid Amp.


Related Content

	CLIA

	Genetics

	International

	TB

	HIV

	IQLM

	MASTER

	Monitoring

	Publications

	Training

Mycobacterium tuberculosis Drug Susceptibility and NTM Testing Performance Evaluation Enrollment Form

Open to all U.S Laboratories only.

At the present time, this program does not accept enrollment laboratories outside of the U.S.

Please provide the following contact information:
( * indicates required information)

Name*
Title*
Lab Name*
Street address*
Address (cont.)
City*
State/ Province*
Zip/Postal code*
Country*
Work Phone*
FAX*
E-mail

Please provide the following shipping information (overnight courier), if different from the contact information specified above or if the address specified above is a post office box (PO Box) - isolates cannot be shipped to a PO box

Name
Title
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
FAX
E-mail

Does your laboratory conduct diagnostic testing for Mycobacterium tuberculosis? *
YesNo
Does your laboratory perform Mycobacterium tuberculosis drug susceptibility testing? *
YesNo
If YES, does your laboratory follow Biosafety Level III practices in performing Mycobacterium tuberculosis susceptibility testing? *
YesNo
Does your laboratory conduct in-house susceptibility testing of non-tuberculous mycobacteria (NTM)? *
YesNo
Which of the following performance evaluation samples would your laboratory like to receive? *
Mtb OnlyNTM OnlyBoth Mtb & NTM
Select the primary classification of your laboratory:*
HospitalIndependentHealth DepartmentOther
If you have any questions please contact us.

This page last reviewed: 11/04/2009

Home

Policies and Regulations

Disclaimer

e-Government

FOIA

Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, U.S.A
Tel: (404) 639-3311 / Public Inquiries: (404) 639-3534 / (800) 311-3435

Department of Health
and Human Services