Infectious Disease Requisition Form

Custom Printed Infectious Disease Requisition Form

This form is designed and printed to be used as an Infectious Disease Requisition, specifically SARS-CoV-2 Assay (COVID-19 Test). It is made with carbonless NCR paper and has multiple parts/copies. Note that we can edit and customize this format to make it more specific to what you need. There is also a set of numbered barcoded labels integrated with the form. The preprinted list of options selections makes it easy and efficient to fill out the form manually or by hand.

USAGE

• Used to record and summarize laboratory testing
• Show the name of the sample tested and testing results
• Track all the points of contact of the sample collected from a patient, from the collection of the sample to analysis.

FEATURES

• 3-Part carbonless form
• Continuous form for prin feed or dot matrix printer
• Consecutively numbered
• Barcoded form and integrated label
• The editable format can be customized to meet your needs