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Reporting, corrections and public health

15 min

Skills you'll build2 skills
  • Distinguish preliminary, final, addendum, and corrected microbiology reports
  • Meet jurisdiction-specific public-health reporting duties for a result

Try first

Try first

A urine culture was finalized as Klebsiella pneumoniae with susceptibilities. Two days later the laboratory finds that the MALDI-TOF spot came from another patient's isolate. This patient's isolate is Proteus mirabilis. What does the laboratory issue?

Keep going to see the reasoning.

Keep going to see the reasoning.

Right. Keep going to follow the reasoning.

Keep going to see the reasoning.

Keep going to see the reasoning.

Get the idea

Use the explanation to check your first decision.

Report status

Microbiology reports often start before testing ends. Every release shows what is known, what is pending and its status.1

StatusMeaning
PreliminaryVerified information released before the planned work is done
FinalThe work planned for the order is complete and released
AddendumInformation added after release, leaving an accurate original unchanged
CorrectedA replacement for information that was wrong when released

A positive blood-culture Gram stain is a typical preliminary result. Its status must be clear, and the report lists pending work when that affects interpretation. Moving from an accurate preliminary result to the final identification and susceptibility is staged reporting. The system keeps a retrievable record of every release, its status and its time.1

Corrected reports

When a reported result proves wrong, CLIA requires the laboratory to promptly notify the person who ordered the test and, when applicable, the person using the result. The laboratory promptly issues a corrected report and keeps the original and the corrected versions. Notification begins when the error is found.1

Public health reporting

Laboratories, clinicians and hospitals must notify public health departments of reportable conditions, and state and local laws define those conditions.2 The jurisdiction's rule also sets who reports, the deadline and route, and whether an isolate must be submitted. One reporter's report satisfies another reporter's requirement only when the rule states this.3

Electronic laboratory reporting (ELR) sends laboratory results to the health department as standard electronic messages.4 When a rule also requires immediate direct notification, the laboratory makes that contact and documents it. Submitting a required isolate is a separate step. The laboratory contacts the public health laboratory first, follows its packaging instructions and documents the transfer. Each required communication is documented separately.3

Follow the bench demonstration

Sources for this step
References
  1. Centers for Medicare & Medicaid Services. State Operations Manual, Appendix C: Survey Procedures and Interpretive Guidelines for Laboratories and Laboratory Services. Rev 236. Issued January 23, 2026. See 42 CFR §493.1291. Accessed September 27, 2026. https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/som107ap_c_lab.pdf
  2. Centers for Disease Control and Prevention. What is case surveillance? National Notifiable Diseases Surveillance System. Updated March 25, 2026. Accessed September 27, 2026. https://www.cdc.gov/nndss/what-is-case-surveillance/index.html
  3. Centers for Disease Control and Prevention. Readers' Guide: Understanding Weekly and Annual National Notifiable Diseases Surveillance System WONDER Tables. Revised December 10, 2024. Accessed September 27, 2026. https://www.cdc.gov/nndss/docs/Readers-Guide-WONDER-Tables-20210421-508.pdf
  4. Centers for Disease Control and Prevention. Electronic laboratory reporting (ELR). Updated May 27, 2026. Accessed September 27, 2026. https://www.cdc.gov/electronic-lab-reporting/php/about/index.html

Watch one

Read each decision and its explanation.

One blood culture produces four releases. Classify each one.

  1. Day 1, 09:10: "Gram-positive cocci in clusters in 1 of 2 bottles. Identification to follow."
  2. Day 1, 11:40: rapid panel from the bottle, Staphylococcus aureus, mecA detected.
  3. Day 2, 15:00: S. aureus, oxacillin resistant, full susceptibilities. Work complete.
  4. Day 3, 08:30: the final report is found to list the source as urine. The specimen was blood.
  1. Release 1 is preliminary.

    A verified finding released before the planned work is done, with pending work named, is a preliminary report.

  2. Release 2 is a preliminary update.

    The rapid result is accurate and the identification and susceptibility are still pending, so it is a staged update.

  3. Release 3 is final.

    The work planned for the order is complete. Moving there from accurate earlier results is staged reporting and needs no correction.

  4. Release 4 needs a corrected report.

    The specimen source is part of the report, and it was wrong when released.

  5. Notify the ordering clinician and keep the original report.

    CLIA requires prompt notification when a reported result is found to be wrong, and both versions are kept in the record.

Releases 1 and 2 are preliminary, release 3 is final, and release 4 is a corrected report with prompt notification of the ordering clinician.

Practice this skill

Your turn

Problem 1 of 3 · Hints available

A preliminary report of gram-positive cocci in clusters is followed the next day by a final identification of Staphylococcus aureus. Separately, an AST report is found to have used the wrong breakpoint table. Which of these requires a corrected report?

Incorrect. Moving from an accurate, clearly incomplete preliminary result to the final identification is staged reporting. A corrected report replaces information that was wrong when released.

Incorrect. The AST report was wrong when released, so it needs a corrected report and prompt notification of the ordering person, with the original kept in the record.

Correct. A correction replaces information that was wrong when released, such as a result interpreted with the wrong breakpoint table. The preliminary Gram stain was accurate and clearly incomplete, so its progression to a final identification is staged reporting, and the system keeps a retrievable chronology of every release.

Hint
  1. Ask whether each earlier release was accurate when it was released.
  2. Staged reporting updates an accurate, incomplete report to the final one.

Review Preliminary, final, added, and corrected reports

Problem 2 of 3 · Hints available

A laboratory transmits all positive results to the health department by electronic laboratory reporting. State law also requires immediate direct notification for a particular organism. What is the laboratory's duty for that organism?

Incorrect. Whether electronic reporting satisfies a duty depends on the jurisdiction, and a required immediate direct notification is a separate duty the laboratory completes.

Correct. Electronic laboratory reporting transmits routine results, but its legal effect depends on the jurisdiction. When state or local law requires immediate direct notification for a result, the laboratory makes that contact and documents it, working from a current jurisdiction-specific list.

Incorrect. State or local law determines who must report to public health. A clinician's report satisfies the laboratory's duty only when the rule says so.

Hint
  1. Look at what the state law requires for this one organism.
  2. Ask who decides whether one kind of report satisfies another.

Review Public-health reporting and referral

Problem 3 of 3 · On your own

A hospital infection preventionist tells the laboratory that she reports every notifiable condition to the county, so the laboratory need not. The county rule names laboratories as reporters and says nothing about one report covering another. What does the laboratory do?

A report from one reporter satisfies another's requirement only when the jurisdiction's rule states this. This rule does not.

Assumed another reporter met the laboratory's duty

Each jurisdiction's rules set who must report, by what route, and how fast. One reporter's action satisfies another's duty only when the jurisdiction's rule says so. Assuming that electronic reporting or the clinician covered an immediate notification can leave a required report unmade.

The county rule names the laboratory as a reporter, so the laboratory must report independently.

The laboratory cannot know what another reporter sends. It must report every result the rule lists.

Review Public-health reporting and referral

Use it

Read the case evidence, then make each decision. The step is complete without it.

  • Jonah Pipkin, 19, MRN 4417208, is a college first-year who arrived in the emergency department with fever and a stiff neck.
  • His CSF Gram stain shows gram-negative diplococci. The critical call was made at 02:40 and documented.
  • The culture grows Neisseria meningitidis the next morning.
  • The state rule: N. meningitidis from a sterile site is reported to the health department by phone at once, and the isolate goes to the state public health laboratory.
Decision 1 of 3

How is the Gram stain released at 02:40?

Culture and identification are still pending. A final status can end follow-up on the work that remains.

Released a preliminary report as final

A preliminary report releases verified findings before the planned work is done, and its status must be clear. Presenting it as final can end follow-up on pending identification and susceptibility results. A later error needs a corrected report, and new information goes in an addendum.

The Gram stain is a verified finding released before the planned work is done. The status and the pending culture are clear on the report.

A positive CSF Gram stain is urgent information for the care team. Waiting for the culture delays a verified finding.

Review Preliminary, final, added, and corrected reports

Decision 2 of 3

The phone report to the health department has been made and documented. What else does the rule require of the laboratory?

The rule lists the phone report and the isolate submission as two duties. Completing one does not complete the other.

Assumed another reporter met the laboratory's duty

Each jurisdiction's rules set who must report, by what route, and how fast. One reporter's action satisfies another's duty only when the jurisdiction's rule says so. Assuming that electronic reporting or the clinician covered an immediate notification can leave a required report unmade.

The rule already requires the isolate. Waiting leaves a required submission undone.

Referral of the isolate is a separate step from the case report. The public health laboratory's instructions govern acceptance and packaging.

Review Public-health reporting and referral

Decision 3 of 3

After the culture is final, the laboratory adds a comment that the isolate was sent to the state public health laboratory. What kind of release is that?

The final culture result was accurate. The referral comment adds information and changes nothing already reported.

A correction replaces information that was wrong when released. Nothing in the final result was wrong.

The culture work is complete. Reopening it as preliminary would misstate its status.

Review Preliminary, final, added, and corrected reports

Each step depends on what each release and each reporting requirement covers. The Gram stain was released as preliminary because the culture was pending. The state rule named two requirements, a phone report and an isolate submission, and each needed its own action and record. The referral note added to an accurate final report is an addendum.

For reference

Sources checked