Get Licking County Health Department Covid-19 Testing Consent Form

Filling out the Licking County Health Department COVID-19 Testing Consent Form online is a straightforward process designed to efficiently collect essential information for COVID-19 testing. This guide provides step-by-step instructions to help you complete the form accurately and effectively.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to access the document and open it in your preferred online editor.
2. Begin with the patient information section. Enter the patient’s name, date of birth, address, city, state, ZIP code, and county. Ensure the information is accurate, as this will be used for identification.
3. Next, provide the phone number, insurance provider, social security number, and email address of the patient. This information helps in communication and verifying health insurance coverage.
4. Indicate whether the patient works outside of the home by selecting ‘Yes’ or ‘No.’ If the answer is ‘Yes,’ specify the workplace and occupation.
5. Answer the question about working while ill by selecting ‘Yes’ or ‘No.’ This information may be relevant for assessing exposure.
6. State whether the patient lives in a congregate setting by choosing ‘Yes’ or ‘No.’ This can include options such as long-term care facilities or shelters.
7. If applicable, indicate if the patient receives dialysis or works in a dialysis facility by selecting ‘Yes’ or ‘No.’
8. List any symptoms currently experienced by the patient. Options include fever, loss of taste or smell, chills, nausea or vomiting, cough, diarrhea, sore throat, abdominal pain, muscle aches, runny nose, headache, or any other symptoms not listed.
9. Proceed to the consent section. Confirm you are either the patient or the legal guardian. Acknowledge the understanding of the testing authorization and methods, as well as any associated risks.
10. Provide your printed name and signature where indicated, along with the date of signing. Review all entered information for accuracy before saving.
11. Finally, save your changes to ensure all information is recorded. You can then choose to download, print, or share the completed form as needed.

Complete your forms online to ensure timely COVID-19 testing and response.