Form preview

Get the free Covid-19 at-home Rapid Test Claims Form

Get Form
This form allows MESSA medical members to request reimbursement for qualifying FDA-authorized COVID-19 at-home rapid antigen or molecular tests purchased between January 15 and January 31, 2022. Members must submit proof of purchase with the completed form to obtain reimbursement.
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign covid-19 at-home rapid test

Edit
Edit your covid-19 at-home rapid test form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your covid-19 at-home rapid test form via URL. You can also download, print, or export forms to your preferred cloud storage service.

How to edit covid-19 at-home rapid test online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
Follow the steps below to use a professional PDF editor:
1
Set up an account. If you are a new user, click Start Free Trial and establish a profile.
2
Prepare a file. Use the Add New button to start a new project. Then, using your device, upload your file to the system by importing it from internal mail, the cloud, or adding its URL.
3
Edit covid-19 at-home rapid test. Rearrange and rotate pages, add new and changed texts, add new objects, and use other useful tools. When you're done, click Done. You can use the Documents tab to merge, split, lock, or unlock your files.
4
Save your file. Select it from your records list. Then, click the right toolbar and select one of the various exporting options: save in numerous formats, download as PDF, email, or cloud.
pdfFiller makes dealing with documents a breeze. Create an account to find out!

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out covid-19 at-home rapid test

Illustration

How to fill out covid-19 at-home rapid test

01
Open the test kit and remove all contents.
02
Place the test device flat on a clean, dry surface.
03
Clean your hands before proceeding.
04
Use the nasal swab to collect a sample from both nostrils as instructed.
05
Insert the swab into the provided solution vial and swirl it around.
06
Remove the swab and discard it properly.
07
Use the dropper to place the specified number of drops from the solution vial into the test device.
08
Wait for the designated time indicated in the instructions (typically 15-30 minutes).
09
Check the result window for a positive, negative, or invalid result.

Who needs covid-19 at-home rapid test?

01
Individuals who have symptoms of COVID-19.
02
People who have been in close contact with someone confirmed to have COVID-19.
03
Those needing to confirm a negative status before attending gatherings or traveling.
04
Anyone who is directed by a healthcare provider to take a test.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.7
Satisfied
20 Votes

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

Once your covid-19 at-home rapid test is ready, you can securely share it with recipients and collect eSignatures in a few clicks with pdfFiller. You can send a PDF by email, text message, fax, USPS mail, or notarize it online - right from your account. Create an account now and try it yourself.
You can make any changes to PDF files, like covid-19 at-home rapid test, with the help of the pdfFiller Android app. Edit, sign, and send documents right from your phone or tablet. You can use the app to make document management easier wherever you are.
Use the pdfFiller mobile app and complete your covid-19 at-home rapid test and other documents on your Android device. The app provides you with all essential document management features, such as editing content, eSigning, annotating, sharing files, etc. You will have access to your documents at any time, as long as there is an internet connection.
The COVID-19 at-home rapid test is a diagnostic tool that allows individuals to test themselves for the presence of the virus in a short amount of time, typically providing results within 15-30 minutes.
Individuals who take a COVID-19 at-home rapid test and receive a positive result may be required to report the result depending on local health guidelines and regulations.
To fill out a COVID-19 at-home rapid test, follow the kit instructions carefully, which typically involve collecting a sample (e.g., saliva or nasal swab), performing the test according to the provided procedure, and recording the result as instructed.
The purpose of the COVID-19 at-home rapid test is to quickly identify individuals who may be infected with the virus, enabling them to take appropriate actions such as self-isolation and informing close contacts.
Individuals may need to report their name, date of birth, contact information, test result, and the date the test was taken.
Fill out your covid-19 at-home rapid test online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.