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  • Resp Surveillance Submission Form 2009-2010.doc

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Ved By: Date/Time Rec'd: Novel H1N1 Influenza Specimen Submission NOTE: All Patient, Submitter, and Specimen Information Sections MUST be completed in their entirety. I. Patient Information Patient's Name: (Last Name, First Name) Patient's Street Address: State: City: Patient's Telelphone #: County: Patient's Date of Birth: (MM/DD/YYYY) Indicate High Risk Testing Criteria: Zip Code: Pregnant women with influenza-like illness Contact Name: Death due to a influenza-like illness Contact P.

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How to fill out the Resp Surveillance Submission Form 2009-2010.doc online

Filling out the Resp Surveillance Submission Form 2009-2010 online is an essential step for submitting specimen information accurately. This guide provides clear instructions on how to complete each section of the form to ensure that all required information is provided for testing purposes.

Follow the steps to fill out the Resp Surveillance Submission Form online.

  1. Click the ‘Get Form’ button to obtain the form and open it in your online editor.
  2. Begin by completing the Patient Information section thoroughly. Enter the patient's full name, address, telephone number, date of birth, and high-risk testing criteria. Be sure to check the box indicating if the patient is pregnant, if the patient has been hospitalized, and whether they were vaccinated for the seasonal flu.
  3. In the Submitter Information section, fill in the submitter's name, address, phone number, and fax number. This information ensures that laboratory results will be reported accurately to the designated individual.
  4. Complete the Specimen Information section by providing the type of specimen, date of collection, and the condition of the specimen when transported. Choose the appropriate specimen type from the provided options.
  5. Ensure all information is accurate and complete. Remember that any missing information could lead to rejection of the specimen.
  6. Once all sections are filled out correctly, you can save your changes, download the document for printing, or share it as required.

Make sure to complete your submission forms online for efficient processing.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
altaFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232