Get the free swine flu requisition form - hcphes

Swine Flu S-OIV Requisition Form Houston Department of Health and Human Services Bureau of Laboratory Services 1115 South Braeswood Dr Houston TX 77030 Ph 713 558-3469 Fax 713 794-9602 ALL OF THE INFORMATION ON THIS FORM IS REQUIRED Collection Date Submitter Address Time Source Submitter Submitter Phone Number Account Submitter Fax Number PATIENT INFORMATION Name Last First MI Address Street City County State Phone Zip Code Medical Record DOB U / SSN - Age Sex Race W White B Black/African...

How to fill out swine flu requisition form

How to fill out swine flu requisition form:

1. Start by obtaining the swine flu requisition form from an authorized healthcare provider or clinic. You may need to visit a designated testing center or hospital to collect the form.
2. Read through the form carefully to understand the information required and any specific instructions provided. Make sure you have all the necessary details and documents ready before filling out the form.
3. Begin by providing your personal information such as your full name, date of birth, address, contact number, and email address. Fill in these details accurately and legibly to avoid any confusion or delays in processing your request.
4. Next, provide relevant medical information, such as any existing medical conditions, allergies, or medications you are currently taking. This information helps healthcare professionals assess your health condition accurately.
5. Indicate the reason for requesting the swine flu test. Whether you are experiencing flu-like symptoms or have been in contact with an infected person, provide a brief explanation in the designated section.
6. Include the date and time of your symptom onset, if applicable, as this information can help track the spread of the virus and determine the urgency of your test.
7. Sign and date the form at the bottom to certify the accuracy of the provided information.
8. If required, make a copy of the completed form for your records before submitting it to the appropriate healthcare provider or designated testing center.
9. Return the filled-out swine flu requisition form to the authorized personnel as instructed. They will guide you further regarding the testing process, sample collection, and result dissemination.

Who needs swine flu requisition form?

1. Individuals experiencing flu-like symptoms such as high fever, body aches, sore throat, cough, and fatigue.
2. Individuals who have been in close contact with a confirmed swine flu case and are exhibiting symptoms or concerned about potential exposure.
3. Healthcare workers and other essential service providers who are at a higher risk of exposure due to their occupation and need to validate their health status.
4. Organizations or institutions implementing preventive measures and conducting surveillance to contain the spread of swine flu in a community or a specific area.
5. Individuals traveling to regions or countries with reported swine flu outbreaks and are required to provide a negative test result before entering those areas.

It is important to note that swine flu requisition forms may vary depending on the healthcare provider or testing facility. Always follow the specific instructions provided and provide accurate information to ensure effective testing and diagnosis.

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What is swine flu requisition form?

The swine flu requisition form is a document used to request specific supplies or services related to swine flu prevention or treatment.

Who is required to file swine flu requisition form?

Healthcare facilities, government agencies, and organizations involved in swine flu response are required to file the swine flu requisition form.

How to fill out swine flu requisition form?

The form must be completed with detailed information about the requested supplies or services, including quantities, specifications, and delivery instructions.

What is the purpose of swine flu requisition form?

The purpose of the swine flu requisition form is to ensure that necessary resources are available for swine flu response efforts.

What information must be reported on swine flu requisition form?

Information such as the requested supplies or services, quantities needed, contact information, and any specific requirements must be reported on the swine flu requisition form.