Clinical Test Request Forms - Human specimens only
- A completed test request form is required to perform testing.
- Affix a patient information label to the test request form or fully complete the information.
- Specimen must have two identifiers that match the test request form.
- Mark the test(s) to be performed.
- Tests on human samples must be ordered by a licensed medical provider.
- How to complete your test request form
COVID-19 Electronic Test Request Form
All facilities should use the "COVID-19/Flu Electronic Test Request Form" that is part of the OpenELIS Web Portal to order the 2019 Novel Coronavirus Diagnostic Test, Influenza SARS-CoV-2 (Flu SC2) Multiplex, SARS-CoV-2 Next Generation Sequencing, and SARS-CoV-2 IgG Antibody tests instead of using the PDF form that is generated below.
Apply for an OpenELIS Web Portal account
