Edit, Download, and Sign the Los Angeles County COVID-19 Test Results Form
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How do I fill this out?
To fill out this form correctly, ensure that you are providing accurate patient information and test results. The form must be typed to avoid rejection by the automated system. Follow the step-by-step instructions to complete each section.
How to fill out the Los Angeles County COVID-19 Test Results Form?
1
Enter medical provider information.
2
Fill in patient details and demographic information.
3
Provide clinical information and test results.
4
Include vaccination information, if applicable.
5
Submit the completed form via fax or secure email.
Who needs the Los Angeles County COVID-19 Test Results Form?
1
Medical providers need this form to report positive COVID-19 test results.
2
Healthcare facilities use this form to document patient information and test outcomes.
3
Public health departments rely on this form to track COVID-19 cases.
4
Infection preventionists use this form to report cases in their facilities.
5
Researchers and analysts use data from this form to study COVID-19 trends and outbreaks.
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1
Open the PDF form on PrintFriendly.
2
Select the text tool to type into the fields.
3
Fill out each section with the required information.
4
Review your entries for accuracy.
5
Save and download your completed form.
What are the instructions for submitting this form?
Send the completed form to the Acute Communicable Disease Control Program by fax at (310) 605-4274 or secure email to COVID19@ph.lacounty.gov. Ensure all sections are filled out accurately and the form is typed to avoid rejection. Keep a copy of the submitted form for your records. Timely submission is crucial for effective monitoring and management of COVID-19 cases.
What are the important dates for this form in 2024 and 2025?
This form should be used throughout 2024 and 2025 to report positive COVID-19 test results. Keep it updated with any new public health guidelines or reporting requirements.
What is the purpose of this form?
The purpose of this form is to enable medical providers to report positive COVID-19 test results to the Los Angeles County Public Health Department. By collecting detailed patient information, test outcomes, and vaccination status, this form helps the public health authorities track and manage the spread of COVID-19. Accurate reporting through this form is essential for effective monitoring and control of the pandemic.
Tell me about this form and its components and fields line-by-line.
- 1. Medical Provider Information: Includes the name, facility, contact number, and email of the reporting medical provider.
- 2. Patient Information: Includes patient's name, date of birth, gender identity, sexual orientation, race/ethnicity, residence type, contact details, and occupation.
- 3. Clinical Information: Covers symptoms, medical conditions, test results, and vaccination details.
- 4. Laboratory Information: Specimen type, collection date, test performed, and lab results.
What happens if I fail to submit this form?
Failing to submit this form can result in inadequate tracking of COVID-19 cases.
- Public Health Impact: Inaccurate data affects the management of the pandemic.
- Compliance Issues: Non-compliance with public health reporting requirements.
- Delayed Response: Delay in contact tracing and mitigation efforts.
How do I know when to use this form?
- 1. Positive PCR/NAAT Results: Report positive PCR or NAAT test results.
- 2. Positive Antigen Tests: Report positive antigen test results.
- 3. LA County Residents: Only for residents of LA County (excluding Pasadena and Long Beach).
- 4. Reporting Timeline: Report results as soon as they are available.
- 5. Confidential Reporting: Ensure all patient information is handled confidentially.
Frequently Asked Question
What information do I need to fill out this form?
You need patient information, test details, clinical information, and vaccination status.
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Is the form submission secure?
The form should be submitted to the provided fax number or secure email for confidentiality.
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What happens if I don't type the form?
The automated system will reject handwritten forms; it must be typed.
Who needs to use this form?
Medical providers, healthcare facilities, public health departments, infection preventionists, and researchers.
Where do I submit the completed form?
Submit via fax to (310) 605-4274 or secure email to COVID19@ph.lacounty.gov.
Can I print the form after filling it out?
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