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COVID-19 TEST REQUEST FORM UTAH PUBLIC HEALTH LABORATORY#FOR PHL USE ONLY4431 SOUTH 2700 WEST TAYLORSVILLE, UTAH 84129 TELEPHONE: (801) 9652400 FAX: (801) 5360473 http://health.utah.gov/lab/infectiousdiseasesDATE

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How to fill out infectious disease test request

01

Obtain the infectious disease test request form from a healthcare provider or laboratory.

02

Fill out your personal information accurately, including your full name, date of birth, and contact information.

03

Provide details about your medical history, including any symptoms or exposure to infectious diseases.

04

Specify the type of infectious disease test you require.

05

Follow any additional instructions provided on the form, such as fasting requirements before the test.

06

Double-check your form for completeness and accuracy.

07

Submit the completed form to the healthcare provider or laboratory as instructed.

Who needs infectious disease test request?

01

Anyone who suspects they may have been exposed to an infectious disease or is experiencing symptoms associated with a particular infectious disease may need to fill out an infectious disease test request. This can include individuals with flu-like symptoms, recent travel to an area with a high prevalence of infectious diseases, or close contact with someone who has a confirmed infectious disease.

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What is infectious disease test request?

Infectious disease test request is a form or request submitted by a healthcare provider to request testing for a specific infectious disease in a patient.

Who is required to file infectious disease test request?

Healthcare providers such as doctors, nurses, and laboratories are required to file infectious disease test requests.

How to fill out infectious disease test request?

To fill out an infectious disease test request, the healthcare provider must provide details about the patient, the suspected infectious disease, and the reason for testing.

What is the purpose of infectious disease test request?

The purpose of an infectious disease test request is to diagnose and monitor the spread of infectious diseases within a population.

What information must be reported on infectious disease test request?

The infectious disease test request must contain information such as the patient's demographics, symptoms, exposure history, and the requested tests.

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