Get the free At Home COVID-19 Test Request FORM - MC1672-56. Home COVID-19 Test Request FORM - Co...
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Reset FormComplete and print. Home COVID-19
Test RequestPatient Name (First, Middle, Last)PharmacyBirth Date (mmddyyyy)Form content not retained in medical record.
For local storage only. Mayo Clinic
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How to fill out at home covid-19 test
How to fill out at home covid-19 test
01
Open the at-home Covid-19 test kit and read the instructions carefully.
02
Collect a sample using the swab provided in the kit.
03
Insert the swab into the provided tube or container with the transport medium.
04
Seal the container and place it in the designated bag or box for shipping.
05
Fill out any required information on the form or label provided.
06
Place the sealed bag or box in the mail or drop off at the designated location for testing.
Who needs at home covid-19 test?
01
Individuals who are experiencing Covid-19 symptoms and want to confirm if they have the virus.
02
Those who have been in close contact with someone who has tested positive for Covid-19.
03
People who have recently traveled to high-risk areas or attended large gatherings.
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What is at home covid-19 test?
At home covid-19 test is a test kit that allows individuals to collect samples at home and send them to a lab for testing to determine if they have contracted the virus.
Who is required to file at home covid-19 test?
Individuals who are experiencing symptoms of covid-19 or believe they have been exposed to the virus are required to use at home covid-19 test.
How to fill out at home covid-19 test?
To use at home covid-19 test, individuals need to follow the instructions provided in the kit to collect the sample and send it to the lab for testing.
What is the purpose of at home covid-19 test?
The purpose of at home covid-19 test is to provide a convenient and accessible way for individuals to test for covid-19 from the comfort of their own homes.
What information must be reported on at home covid-19 test?
Individuals need to report their personal information, including name, date of birth, and contact information, when filling out at home covid-19 test.
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