Results Form
Demographics
Unique case id:
Family Name:
Given Name:
Middle Name:
Name:
Gender:
...
Male
Female
Date of birth:
COVID test result to input:
*
Molecular test
Serological test
Molecular testing method and results set
Date sample collected
*
Type of sample
*
Type of test
*
Date sample received
*
Results
*
...
Positive for COVID-19
Negative for COVID-19
Positive for other pathogens
Indeterminate
Specify pathogen
*
Result date
*
Specimen shipped to other laboratory for confirmation
*
...
Yes
No
Date
*
Laboratory name
*
Serology testing method and results set
Date sample collected
*
Type of sample
*
Type of test
*
Date sample received
*
Results
*
...
Positive for IgM only
Positive for IgG only
Positive for both IgM and IgG
Positive
Negative
Inconclusive
Invalid
Titre
*
Result date
*
Specimen shipped to other laboratory for confirmation
*
...
Yes
No
Date
*
Laboratory name
*
Encounter Location:
*
Provider Name:
*
Provider’s System ID:
*
Encounter Date:
*