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INFECTIOUS DISEASE 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
How to fill out infectious disease test request
01
Obtain the infectious disease test request form from a healthcare provider.
02
Fill out all required personal information including name, date of birth, contact information, etc.
03
Specify the type of infectious disease test being requested.
04
Provide any relevant medical history or symptoms that may help in interpreting the results.
05
Sign and date the form to confirm accuracy of information provided.
06
Submit the completed form to the designated healthcare facility for testing.
Who needs infectious disease test request?
01
Individuals who are experiencing symptoms of infectious diseases.
02
People who have been in close contact with someone diagnosed with an infectious disease.
03
Healthcare workers who may have been exposed to infectious agents.
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