COVID-19 Test Report

Healthcare Clinic
Name of Lab/Site Performing Test
CLIA Number/Waiver
Healthcare Clinic Address
Healthcare Clinic Phone Number

Patient Information:

Last Name
First Name
Date of Birth (mm/dd/yyyy)

Test Information:

Test Performed	PCR
Sample Collection Date
Sample Reference ID# Or Unique Test Result ID#

Test Result:

To learn more about the technology used to process your test, click here

To learn more about the technology used to process your test, click here

To learn more about the technology used to process your test, click here