Amended Information for Submitted Samples
Idaho Bureau of Laboratories
Please complete the following form to amend information for previously submitted sample(s).
Office Use Only:  IBL staff, please complete the information below and submit completed form to OS2 for HCM upload.

IBL Staff Name:  ________________________________________                             Lab ID, if not provided on form:  ___________________________

Date changes made in Horizon:  ___________________________                     Date uploaded to HCM:  __________________________________
This is a secure web site.  Data sent on this form will be encrypted and meets HIPAA guidelines/standards.  The information will be used solely by Idaho Bureau of Laboratories (IBL) and only in relation to testing and resulting of samples submitted for analysis.
Please supply the following information (required):

Please supply the following information (optional):


Clinical Samples

Emergency Preparedness Samples

Environmental Samples

Check if you need a copy of your original submission form sent to you.