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Zika Virus Test Requisition All fields must be completed for test to be processed. Each sample must be accompanied by a separate form REQUIRED INFORMATION For Lab Use Only Specimen Type Check only one Patient Information Serum CSF Urine MR ID Name Address CityState Zip Sex Race DOB Amniotic fluid Other Date of Collection Time of Collection AM / PM Epidemiological Information Must have to test Mississippi Public Health Laboratory 570 East Woodrow Wilson Drive F.E. Ed Thompson Jr Building...
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How to fill out zika virus test requisition
How to fill out zika virus test requisition
01
Step 1: Obtain a zika virus test requisition form from your healthcare provider or medical facility.
02
Step 2: Fill out the personal information section on the form, including your name, date of birth, gender, and contact information.
03
Step 3: Provide information about your travel history to areas affected by zika virus, including countries visited and dates of travel.
04
Step 4: Answer questions about any symptoms you may be experiencing, such as fever, rash, joint pain, or red eyes.
05
Step 5: If you are pregnant or planning to become pregnant, indicate it on the form.
06
Step 6: Sign and date the requisition form, confirming that the information provided is accurate.
07
Step 7: Submit the filled-out form to your healthcare provider or the designated testing facility.
08
Step 8: Follow any additional instructions given by your healthcare provider regarding the zika virus test.
Who needs zika virus test requisition?
01
Individuals who show symptoms of zika virus infection, such as fever, rash, joint pain, or red eyes.
02
Pregnant women or women planning to become pregnant, as zika virus can have severe consequences for unborn babies.
03
People who have recently traveled to areas affected by zika virus, especially if they have experienced symptoms.
04
Individuals who have been in contact with someone diagnosed with zika virus or have a history of sexual exposure to the virus.
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