Get Ca Covid-19 Specimen Intake Form 2020-2026

Filling out the CA COVID-19 Specimen Intake Form is an essential step for healthcare providers to collect vital information about patients potentially affected by COVID-19. This guide provides clear instructions for users to complete the form efficiently online.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to access the CA COVID-19 Specimen Intake Form and open it in your preferred online editor.
2. Begin with the patient details section. Fill in the patient's Medical Record Number (MRN), full name, age, address, and primary phone number. If applicable, indicate if the patient is homeless and whether they are pregnant.
3. Provide the patient's gender, primary language, occupation, and their height and weight. Ensure that all details are accurate.
4. In the clinical details section, indicate if the patient is experiencing any COVID-19 symptoms such as fever or cough. Specify if the patient is currently hospitalized or in an ICU setting.
5. Address any underlying medical conditions by indicating 'yes' or 'no' for conditions like asthma, diabetes, heart disease, or cancer. If there are other conditions, specify them in the provided field.
6. Complete the exposures section. Indicate if the patient has traveled from a location with endemic COVID-19 or had contact with a confirmed or suspected case. Provide details of residence, school, or workplace settings.
7. In the other testing section, tick the results of any tests that have been performed, including rapid tests for influenza, RSV, and various coronaviruses. Note if testing is pending or not done.
8. Fill in details about any radiographic imaging performed, marking the findings regarding chest X-rays and CT scans.
9. Finally, input the submitting physician's name, facility name, mailing address, facility phone number, facility fax number, and the National Provider Identifier (NPI) number.
10. Review all entered information for accuracy. Once satisfied, save the changes, then proceed to download, print, or share the completed form as needed.

Take the necessary steps to complete your documents online.