Get Swine Flu Requisition Form

This guide provides comprehensive instructions on how to accurately complete the Swine Flu Requisition Form online. By following these steps, users can efficiently submit necessary information for effective health management.

Follow the steps to fill out the Swine Flu Requisition Form correctly.

1. Click the ‘Get Form’ button to obtain the Swine Flu Requisition Form and open it in your online editor.
2. Enter the collection date in the designated section.
3. Provide your address in the submitter address field.
4. Fill in the time of submission.
5. Indicate the source of the sample in the appropriate field.
6. Complete the submitter information, including your name, phone number, account number, and fax number.
7. In the patient information section, enter the patient's name, address, phone number, medical record number, date of birth, social security number, age, sex, race, and ethnicity.
8. Record the onset date and duration of illness in the clinical data section.
9. Specify whether the patient was hospitalized and check all applicable symptoms.
10. In the lab data section, record the laboratory test results and the date the rapid test was performed.
11. Answer the epidemiological data questions regarding contact with confirmed cases and residency in long-term care or educational facilities.
12. Add any additional comments in the comments section.
13. After completing all sections, save your changes, and choose to download, print, or share the form as needed.

Complete your Swine Flu Requisition Form online today to ensure timely processing of your request.