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COVID-19 SPECIMEN SUBMISSION FORM MA STATE PUBLIC HEALTH LABORATORY 305 SOUTH STREET, JAMAICA PLAIN, MA 021303597 PRINT LEGIBLY, APPLY LABEL OR STAMP: DO NOT ABBREVIATE ONLY ONE TEST/SPECIMEN PER

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How to fill out covid-19 specimen submission form

01

To fill out the COVID-19 specimen submission form, you need to follow these steps:

02

Start by providing personal information such as your name, date of birth, and contact details.

03

Indicate if you have any known symptoms related to COVID-19.

04

Specify the reason for submitting the specimen, such as being symptomatic, contact with a confirmed case, or for travel purposes.

05

Provide detailed information about your recent travel history, if applicable.

06

Enter the date and time of specimen collection.

07

Mention the type of specimen being submitted, such as nasal swab, throat swab, or blood sample.

08

Include any relevant medical history, allergies, or underlying conditions.

09

Sign and date the form to certify its accuracy.

10

Submit the form along with the collected specimen to the designated laboratory or healthcare facility.

11

Note: Follow any specific instructions or guidelines provided by the healthcare provider or testing facility.

Who needs covid-19 specimen submission form?

01

Anyone who requires a COVID-19 test or is advised to submit a specimen for testing needs the COVID-19 specimen submission form.

02

This includes individuals who show symptoms of COVID-19, have been in contact with a confirmed case, or need to undergo testing for travel purposes.

03

The form allows healthcare providers to collect essential information and ensure proper tracking and processing of the submitted specimen.

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What is covid-19 specimen submission form?

The COVID-19 specimen submission form is a document used to collect detailed information about samples being submitted for COVID-19 testing. It ensures proper tracking and processing of the specimens.

Who is required to file covid-19 specimen submission form?

Healthcare providers, laboratories, and entities that collect specimens for COVID-19 testing are required to file the COVID-19 specimen submission form.

How to fill out covid-19 specimen submission form?

To fill out the COVID-19 specimen submission form, you need to provide information such as patient details, specimen type, collection date, and any relevant clinical information as specified by the guidelines.

What is the purpose of covid-19 specimen submission form?

The purpose of the COVID-19 specimen submission form is to ensure the accurate identification, tracking, and processing of specimens submitted for COVID-19 testing, facilitating efficient testing and reporting.

What information must be reported on covid-19 specimen submission form?

The form must report information such as patient demographics, specimen type, test requested, collector's information, and any relevant clinical history.

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