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INFECTIOUS DISEASE TEST REQUEST FORM LAB#FOR UPHL USE ONLY UTAH PUBLIC HEALTH LABORATORY4431 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 your healthcare provider or laboratory.
02
Fill in the patient's personal information, including full name, date of birth, and contact details.
03
Specify the type of test or tests required based on symptoms or exposure.
04
Provide relevant medical history and any recent travel or exposure that may relate to the infection.
05
Indicate any current medications or allergies.
06
Include the date and signature of the requesting physician or healthcare provider.
07
Submit the completed form to the laboratory along with any required samples.
Who needs infectious disease test request?
01
Individuals showing symptoms of an infectious disease.
02
Patients who have been exposed to a known infectious disease.
03
Travelers returning from areas with endemic diseases.
04
Healthcare workers assessing potential workplace exposures.
05
Individuals undergoing routine screenings for health assessments.
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What is infectious disease test request?
An infectious disease test request is a formal document submitted to healthcare authorities or laboratories to request testing for specific infectious diseases, allowing for proper diagnosis and treatment.
Who is required to file infectious disease test request?
Healthcare providers, such as doctors and laboratories, are typically required to file infectious disease test requests on behalf of patients who show symptoms or are at risk of infectious diseases.
How to fill out infectious disease test request?
To fill out an infectious disease test request, provide patient demographics, clinical information, the specific tests requested, and sign the form to certify accuracy.
What is the purpose of infectious disease test request?
The purpose of an infectious disease test request is to facilitate the diagnosis, monitoring, and treatment of infectious diseases through appropriate laboratory testing.
What information must be reported on infectious disease test request?
Information that must be reported includes patient identification details, symptoms, medical history, the specific test required, and the requesting provider's information.
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