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DEPARTMENT OF HEALTH SERVICE Division of Public Health F02436 (02/2020)STATE OF WISCONSIN Wis.Stat. 252.12(13)TESTING QUESTIONNAIRE Test ID A# Sticker Here Today's Date://Date of Birth: /State Where
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How to fill out covid-19wisconsin state laboratory of

01
Obtain a COVID-19 test requisition form from a healthcare provider.
02
Fill out the patient information section completely including name, date of birth, address, and contact information.
03
Specify the reason for the test by checking the appropriate box or providing additional information if needed.
04
Provide insurance information if applicable.
05
Follow any additional instructions provided by the healthcare provider or the Wisconsin State Laboratory of Hygiene.

Who needs covid-19wisconsin state laboratory of?

01
Individuals who are experiencing symptoms of COVID-19 such as fever, cough, and shortness of breath.
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Individuals who have been in close contact with someone diagnosed with COVID-19.
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Healthcare workers and first responders who may have been exposed to the virus.
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Individuals who are planning to travel to areas with high rates of COVID-19 transmission.
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The Wisconsin State Laboratory of Hygiene is a public health laboratory responsible for testing and analyzing samples related to COVID-19.
Healthcare providers, hospitals, and testing facilities are required to file COVID-19 testing samples to the Wisconsin State Laboratory of Hygiene.
COVID-19 testing samples can be filled out and submitted electronically or physically to the Wisconsin State Laboratory of Hygiene following their specific guidelines and protocols.
The purpose of the Wisconsin State Laboratory of Hygiene is to track, monitor, and analyze COVID-19 testing samples to help public health officials in controlling the spread of the virus.
The necessary information to report on COVID-19 testing samples includes patient demographics, test results, date of sample collection, and testing location.
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