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The "Notification From Medical Provider of COVID-19 Laboratory Results" form is a critical communication tool used by healthcare providers to report laboratory-confirmed COVID-19 cases. It ensures that local health authorities, such as the Acute Communicable Disease Control Program in Los Angeles County, receive accurate and timely information about COVID-19 test outcomes. This form includes essential sections such as medical provider details, patient information, clinical and laboratory results, and epidemiological risk factors, allowing for a comprehensive overview of each reported case.
To effectively use the "Notification From Medical Provider of COVID-19 Laboratory Results" form, healthcare providers should follow these steps:
Prepare Required Information: Before filling out the form, gather all necessary patient and laboratory information, including the patient's name, date of birth, and contact details, as well as the specifics of the COVID-19 test conducted.
Complete the Form Sections:
Review for Accuracy: Double-check all entries to ensure correctness and completeness, as errors can delay the processing and response by public health authorities.
Submit to Authorities: Send the completed form to the designated local health department via the prescribed method, typically through secure electronic submission platforms or by mail.
Completing this form involves ensuring that all entries are accurate and up to date. The following guide outlines the steps to fill it out:
Enter Medical Provider Information
Detail Patient Information
Input Clinical Information:
Provide Laboratory Test Results:
Add Epidemiological Risk Factors:
Submit the Form:
The form's design ensures comprehensive data collection crucial for managing COVID-19 cases. Key elements include:
This form serves a significant legal function by enabling compliance with public health reporting mandates. Healthcare providers must report COVID-19 cases in accordance with local, state, and federal laws. Failure to do so can result in penalties or legal action. This ensures prompt public health responses to control the spread of the virus.
This form is primarily used by:


Reporting requirements can vary by state. For example, California mandates immediate reporting of positive COVID-19 results to local health departments. Some states may have additional documentation requirements or different submission procedures. It's essential for healthcare providers to be aware of and follow state-specific guidelines to maintain compliance.
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| Versions | Form popularity | Fillable & printable |
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| 2025 | 4 Satisfied (34 Votes) | |
| 2025 | 4.8 Satisfied (31 Votes) | |
| 2025 | 4.3 Satisfied (34 Votes) | |
| 2025 | 4.2 Satisfied (34 Votes) | |
| 2025 | 4.6 Satisfied (55 Votes) | |
| 2025 | 4.5 Satisfied (44 Votes) | |
| 2025 | 4.2 Satisfied (37 Votes) | |
| 2025 | 4.7 Satisfied (34 Votes) | |
| 2024 | 4.3 Satisfied (21 Votes) | |
| 2024 | 4.6 Satisfied (51 Votes) | |
| 2024 | 4.5 Satisfied (23 Votes) | |
| 2024 | 4.8 Satisfied (29 Votes) | |
| 2024 | 4.1 Satisfied (28 Votes) | |
| 2024 | 4.9 Satisfied (51 Votes) | |
| 2024 | 4.4 Satisfied (31 Votes) |
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Nov 11, 2025 Currently, test results will be available within 1 3 days of receipt of the specimen at WSLH. Results will not be called to the submitter. AllRead more
Test data submitted to NHSN will be reported to appropriate state and local health departments using standard electronic laboratory messages. Submit laboratory