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EXAS COVID-19 Test Requisition Form - WI - Test Menu 2026
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- Click ‘Get Form’ to open the EXAS COVID-19 Test Requisition Form in our editor.
- Begin by filling out the 'Provider & Order Information' section. Enter the healthcare organization name, provider name, and NPI number. Ensure you include the appropriate diagnostic codes that reflect the reason for testing.
- In the 'Specimen Type' section, select the method of specimen collection such as Nasopharyngeal Swab or Throat Swab. Fill in the collection date and time accurately.
- Proceed to 'Patient Demographics'. Complete all required fields including Patient ID/MRN, DOB, first and last name, and contact numbers. Make sure to indicate the patient's ethnicity and race as applicable.
- Finally, ensure that you sign and date the certification statement confirming your authority to order this test before submitting.
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Related links
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.
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