Get Ut Public Health Laboratories Novel Influenza A (h1n1) Test Request Form 2009-2025

This guide provides comprehensive instructions for users on how to effectively complete the UT Public Health Laboratories Novel Influenza A (H1N1) Test Request Form online. By following these steps, you can ensure that the form is filled out accurately and completely to facilitate the testing process.

Follow the steps to successfully complete the test request form.

1. Click ‘Get Form’ button to retrieve the UT Public Health Laboratories Novel Influenza A (H1N1) Test Request Form and open it in the designated form editor.
2. Begin by entering patient information in the designated fields. You will need to provide the patient's full name in the format of Last, First, and their patient ID number.
3. Input the patient’s date of birth using the mm/dd/yy format and their age in years. Ensure this information is entered accurately for proper identification.
4. Select the patient’s sex by checking the appropriate box, either Male (M) or Female (F).
5. Fill in the provider information, including the provider code and the name of the physician overseeing the test.
6. Enter the provider’s contact details, including phone number, email address, and secure fax number for communication purposes.
7. Record the specimen collection date again using the mm/dd/yy format.
8. Select the specimen source/site by choosing one option from the provided list, such as nasopharyngeal swab, nasal swabs, or throat swabs.
9. Complete the clinical/epidemiologic criteria for testing section by indicating which criteria are met for the patient. This is necessary for the submission of the test request.
10. After filling out all required fields, review the form for any errors or missing information before finalizing your submission.
11. Once you have checked everything, proceed to save changes, download, print, or share the form as needed to ensure it reaches the laboratory.

Complete your documents online to ensure efficient and accurate test requests.