Form Dhhs 3722 - Hepatitis Serology Page 2
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1
2INSTRUCTIONS
PURPOSE: Submission of specimens for Hepatitis B and Hepatitis A testing.
PREPARATION: Submit at least 2 mL of serum in a plastic screw-capped vial. Clearly label each specimen with the patient's fi rst and
last name, and either date of birth, patient number or other unique identifi er. Specimens without names or incorrectly labeled specimens
will be deemed unsatisfactory for testing. For additional information, see "SCOPE, A Guide to Services" on our website at
or contact the Virology/Serology Unit at (919) 733-7544.
PREPARATION OF FORM: Please print legibly or use a preprinted label. To avoid delays in testing, fi ll out all items in Sections 1 through
8 of the submission form. The information in Section 8 will be used to determine which hepatitis markers will be tested and the eligibility
of the specimen for testing (see "HEPATITIS TESTING PANELS AND CORRESPONDING MARKERS" below). Prior arrangements are
required before submitting specimens for Hepatitis A outbreaks and other situations addressed in Section 8. To make arrangements, call
(919) 733-7544; indicate on request form that such arrangements were made.
SHIPMENT: Send properly identifi ed specimen and completed submission form to the Laboratory as soon as possible. Additional serum
transport tubes and buff-label specimen mailers for Hepatitis Serology are available through the NCSLPH online supply ordering system
on our website at .
DISPOSITION: This form may be destroyed in accordance with Standard 5. Patient Clinical Records, of the Records Disposition Schedule
published by the N.C. Division of Archives and History.
HEPATITIS TESTING PANELS AND CORRESPONDING MARKERS
MARKER
PANEL
POPULATION
Anti-HBc
Anti-HBc
Anti-HAV
2
4
5
HBsAg
IgM
Anti-HBs
Total
IgM
1
3
Hepatitis
Symptomatic
X
X
X
Diagnostic
Hepatitis B
Prenatal
X
X
Screen
if HBsAg (+)
Refugee
X
X
X
if HBsAG (+)
Sexual or needlesharing contact of
known infected person OR
X
X
X
Household contact of chronic HBV
if HBsAg (+)
if HBsAg (-)
carrier or acute cases
Source patient from whom
X
X
exposure occurred
if HBsAg (+)
Hepatitis B
Follow-up of infant (12-15 months)
X
X
Monitor
born to infected mother
Follow-up of person with previous
X
X
X
positive test for HBsAg or history
of HBV infection
Previously vaccinated health
X
department employee with
percutaneous exposure to HBV
Hepatitis A
X
Outbreak
HBsAG
Hepatitis B Surface Antigen (Australia Antigen)
1
Anti-HBcIgM
IgM Antibody to Hepatitis B Core Antigen
2
Anti-HBs
Antibody to Hepatitis B Surface Antigen
3
Anti-HBc
Antibody to Hepatitis B Core Antigen
4
Anti-HAVIgM
IgM Antibody to Hepatitis A Virus
5
DHHS 3722 (Revised 08/13)
Laboratory (Review 08/16)
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