Get Influenza Specimen Submission And Test Result Form

Completing the Influenza Specimen Submission And Test Result Form is essential for the timely testing of influenza specimens. This guide provides a comprehensive overview of how to accurately fill out the form online to ensure that all necessary information is provided.

Follow the steps to successfully complete the online form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient's details in the 'Patient' section. Fill in their last name, first name, and date of birth in the specified fields. Additionally, complete the patient ID or medical record number and the address information.
3. Move to the 'Submitter' section. Here, provide the name of the physician, hospital, lab, or clinic submitting the specimen. It is crucial to ensure that all information is accurate.
4. In the 'Specimen' section, detail the county, zip code, contact phone numbers, and the date of specimen collection. Also, include the contact person's last and first name along with their address and other contact information.
5. Complete the 'Influenza Rapid Test Results' subsection. Indicate the type of specimen collected, such as throat swab or NP swab, and mark the result of the rapid test. Provide any additional comments as necessary.
6. Proceed to the 'Epidemiology' section. Here, document the date of symptom onset and answer the yes/no questions regarding the patient's health status, hospitalization, pregnancy, occupation, and living situation.
7. In the laboratory section, leave this area blank as it is for the DCHHS lab use only. Ensure that the form is complete and accurately reflects all information collected.
8. Once all fields are filled, save changes. You can choose to download, print, or share the form depending on your need.

Complete your Influenza Specimen Submission And Test Result Form online today for efficient processing.