**Please note, the online COVID-19 testing request form is no longer available.** Testing capacity at commercial, private, and hospital laboratories performing SARS-CoV-2 testing continues to increase in Virginia. As a result, Virginia's state laboratory, the Division of Consolidated Laboratory Services (DCLS), will transition its services to support public health testing reserved for outbreaks, contacts of case-patients, un- or underinsured persons, and workers and residents in congregate settings as outlined in the VDH testing criteria . If testing in the private sector is not available and you believe public health testing is warranted, please contact your local health department to discuss public health testing options.
The COVID-19 Testing Request Form was developed to streamline and expedite the approval process for COVID-19 testing at the DCLS. Due to a limited number of tests available, public health testing performed at DCLS is reserved for patients who meet VDH Updated Guidance on Testing for COVID-19 . Click the blue link to open current guidance in a new tab or review a summary of the current guidance is below.
Items to remember when considering testing:
Advise patients with mild illness to isolate at home, according to CDC recommendations . Virginia's local health departments do not provide primary care and thus are not equipped to clinically evaluate patients with respiratory symptoms. At this time, local health departments are not providing COVID-19 testing. Please do not refer your patients to a local health department for testing. VDH cannot supply swabs and other specimen collection supplies that are used for the collection of specimens for COVID-19 testing . Summary of VDH Guidance on Testing for COVID-19 at DCLS: Healthcare worker or first responder with COVID-19 symptoms* Person hospitalized with COVID-19 symptoms* Person with COVID-19 symptoms* AND who resides or works or is about to be admitted into a congregate setting (e.g., homeless shelter, assisted living facility, group home, prison, detention center, jail, or nursing home). Clinicians can submit specimens to DCLS to inform the discontinuation of transmission-based precautions using the test-based strategy on patients diagnosed with COVID-19 returning to a congregate setting. Person with COVID-19 symptoms* AND underlying condition that increases the risk of severe COVID-19 (e.g., aged 65 years or older, person with chronic heart or lung disorder, diabetes, or on dialysis, etc.). Until more information is available, VDH is including pregnant women in this category. Un- or underinsured person with COVID-19 symptoms* Newborn of mother diagnosed with COVID-19 Potential cluster of unknown respiratory illness, with priority for healthcare facility outbreaks.** *COVID-19 symptoms can include fever or cough or shortness of breath or difficulty breathing or sore throat. Fever might not be present in some persons, such as the very young, older adults, or immunosuppressed persons. In older adults, atypical symptoms may include new or worsening malaise, new dizziness or increased falls, mild mental status change such as confusion, nausea, diarrhea, or sore throat.
**DCLS will continue to test specimens for outbreaks and clusters. Once an outbreak has been established, facilities wishing to conduct point prevalence surveys should contact their local health department to coordinate testing. Do not submit requests for point prevalence surveys through the REDCap Testing Portal.
The health department may also provide testing at DCLS for groups from under resourced communities who have limited access to testing and other testing on a case-by-case basis.
If your patient meets any of these VDH criteria for testing for COVID-19, please click ✓ button to proceed with your COVID-19 Testing Request. Form Guidance for Healthcare Professionals: Accuracy and completeness of the Testing Request Form is vital to streamline assessments of COVID-19 testing requests. VDH staff intends to respond to the initial testing requests by e-mail within 3 hours during normal business hours (9:00AM - 5:00PM, Monday - Sunday). If testing requests are submitted outside of normal business hours or there is a high volume of requests, there may be a delay in VDH's response. We will respond to your requests as quickly as possible and contact you once your request has completed the Final Assessment and testing is approved or denied. If you need a more immediate response, please reach out to your local health department directly. Review General Outline of COVID-19 Testing Requests below before continuing to request form.
General Outline of COVID-19 Testing Requests will show as followed: Healthcare provider submits COVID-19 Testing Request at DCLS on this Form Ill person does NOT meet VDH Investigation Criteria for COVID-19 Testing at DCLS Stop this request and pursue alternative COVID-19 Testing at private clinical laboratories. Ill person does meet VDH Investigation Criteria for COVID-19 Testing at DCLS If Ill person meets VDH Investigation Criteria for COVID-19 Testing at DCLS the testing request will be triaged to VDH Epidemiologist who will make Final Assessment to approve or deny COVID-19 Testing at DCLS. At this point collect specimens. Do not wait for health department approval in order to collect specimens. If this request is denied, consider testing through a private laboratory. For COVID-19 testing at DCLS, collect one nasopharyngeal swab in viral transport media. Updated instructions are available on the DCLS website . (Click blue link to open in new tab!) Do not ship specimens without prior VDH approval. The requester will receive an email notification indicating final assessment of approval or denial of the testing request within 3 hours. If the Final Assessment is denied Stop this request and pursue alternative COVID-19 Testing at private clinical laboratories. If the Final Assessment is approved You will be contacted by VDH Epidemiologists and given a DCLS Tracking ID number and guidance to coordinate specimen submission for COVID-19 testing at DCLS.
Public health testing capabilities are limited at this time. Priority groups for testing have been developed with high-risk and vulnerable populations in mind. Please acknowledge, if testing is critical and cannot be supported by public health, providers should seek testing through a private laboratory.
I acknowledge I read and understand the above statement.
* must provide value
Yes
No
Are you sure you would like to end this Testing Request?
* must provide value
Yes
No
Please review acknowledgment above to continue to Testing Request Form. Please indicate if you are a Healthcare Provider OR VDH Staff Member attempting to submit a COVID-19 Testing Request.
* must provide value
Healthcare Provider or Designee
VDH Local Health District Staff
If you are already aware of a VEDSS ID for this person, enter VEDSS ID. If you need a VEDSS ID to be created by the Central Office Review Team, leave this field blank.
Has this COVID-19 Testing Request already been approved by the Local Health District and/or Regional Epidemiologist?
Note, you will still need to submit this form to coordinate submission with DCLS. This submission will not change or alter your approval status of the specimen for testing.
* must provide value
Yes
No
If this person is associated with a suspected cluster or outbreak, please enter VOSS ID and/or setting description, if available.
Note, this will help DCLS link specimens to the correct outbreak, but is not required and can be linked via patient and facility information.
Submitters must be willing and capable of collecting and packaging specimens, and either delivering them to a DCLS courier site or shipping them via commercial courier (e.g, FedEx).
Click ✓ button to proceed to COVID-19 Testing Request Form. This person has COVID-19 symptoms*.
* must provide value
Yes
No
*COVID-19 symptoms can include fever or cough or shortness of breath or difficulty breathing or sore throat. Fever might not be present in some persons, such as the very young, older adults, or immunosuppressed persons. In older adults, atypical symptoms may include new or worsening malaise, new dizziness or increased falls, mild mental status change such as confusion, nausea, diarrhea, or sore throat.
This person is a healthcare worker OR first responder .
* must provide value
Yes
No
Specify type of of healthcare worker or first responder:
EMS Hospital Primary Care Long-term Care and/or Assisted Living Facility Other
Did this person have an occupational exposure?
Yes
No
This person has been admitted to the hospital.
* must provide value
Yes
No
This person typically resides or works or is about to be admitted into a highrisk congregate setting*.*Congregate setting includes: (e.g., homeless shelter, assisted living facility, group home, prison, detention center, jail, or nursing home).
Yes
No
Specify congregate setting type:
Homeless shelter Assisted living facility Nursing home Group home Prison Detention center Jail Schools and universities Public safety Places of worship Other
Specify other:
* must provide value
Name of congregate setting:
This person resides or works or is about to be admitted into a congregate setting*.
*Congregate setting includes: homeless shelter, assisted living facility, group home, prison, detention center, jail, or nursing home.
* must provide value
Yes
No
Specify congregate setting type:
Homeless shelter Assisted living facility Nursing home Group home Prison Detention center Jail Schools and universities Public safety Places of worship Other
Specify other:
* must provide value
Name of congregate setting:
This person has an underlying condition* that increases the risk of severe COVID-19.*Underlying conditions include persons aged 65 years or older, person with chronic heart or lung disorder, diabetes, or on dialysis, etc. Until more information is available, VDH is including pregnant women in this category.
* must provide value
Yes
No
Please specify underlying condition(s) that increases the risk of severe COVID-19. Until more information is available, VDH is including pregnant women in this category.
Answers to this will not impact your Testing Reqest submission.
This person is un- or underinsured.
* must provide value
Yes
No
This person is a newborn of a mother diagnosed with COVID-19.
* must provide value
Yes
No
Please provide the newborn mother's name if available.
First and Last Name
This person is included in a potential cluster of unknown respiratory illness .*Note, priority is given for healthcare facility outbreaks. All suspected clusters or outbreaks should be reported to your local health department .
* must provide value
Yes
No
Please provide a brief description of the setting of suspected cluster.Note, this will be used for VDH for data quality and investigation purposes.
* must provide value
i.e. facility name and/or location and/or description of setting etc.
Yes
No
Unknown
Who was this reported to at the Health Department?
Please provide a full name if available
This person does NOT meet VDH Investigation Criteria for COVID-19 Testing at DCLS.
Stop this request and pursue alternative COVID-19 Testing at private clinical laboratories.
If you feel this person should qualify for COVID-19 Testing at DCLS, please provide a brief description of reason why requesting public health testing, and you will be contacted by a VDH Epidemiologist if the testing request is approved.
Please provide a brief description of reason(s) why requesting COVID-19 Testing at DCLS, even though the patient does not meet the current Guidance on Testing for COVID-19 at DCLS .
* must provide value
Please write in full and complete sentences.
Note: VDH cannot ensure a 3 hour turnaround time for requests submitted that do not meet current VDH criteria for testing for COVID-19. Testing Requests will be reviwed sameday as time permits.
Clinical diagnosis of COVID-19 is a reportable condition, regardless of whether testing is pursued or not. Utilize the VDH Online Morbidity Report Portal to report individual cases that do not meet the criteria for public health testing at DCLS. (Click the blue link to open in new tab!)
Click ✓ button to proceed to proceed to information section.
Requesting VDH LHD Staff Information VDH LHD Requester Name:
* must provide value
First and Last Name
i.e. Epidemiologist, Public Health Nurse, Disease Investigator, etc.
Local Health District
* must provide value
Alexandria Alleghany/Roanoke Arlington Central Shenandoah Central Virginia Chesapeake Chesterfield Chickahominy Crater Cumberland Plateau Eastern Shore Fairfax Hampton Henrico Lenowisco Lord Fairfax Loudon Mount Rogers New River Norfolk Peninsula Piedmont Pittsylvania-Danville Portsmouth Prince William Rappahannock Area Rappahannock-Rapidan Richmond City Southside Thomas Jefferson Three Rivers Virginia Beach West Piedmont Western Tidewater Central Office
VDH LHD Requester Email:
This email address will be used to track COVID-19 Laboratory Testing Request, and sent information regarding the DCLS Tracking ID.
* must provide value
Email will be used for tracking COVID-19 Testing Request
VDH or LHD Requester Phone Number:
* must provide value
Phone number preferred for rapid contact if warranted.
Please note, providers and staff may not request their own testing. These requests will be denied. Please have some one submit this request on your behalf if you feel public health testing is warranted.
Name of person submitting this request:
* must provide value
First and Last Name
Submitter Email:
This email address will be used to track COVID-19 Laboratory Testing Request, and to provide information for DCLS submission if approved for testing.
* must provide value
Email will be used for tracking COVID-19 Testing Request
Are you willing and capable of collecting and packaging specimens, and either delivering them to a DCLS courier site or shipping them via commercial courier (e.g, FedEx)?
* must provide value
Yes
No
Attending Clinician Information Attending Clinician First and Last Name:
* must provide value
First and Last Name
Specify Attending Clinician Credentials:
i.e. MD, DO, PA, NP etc.
Attending Clinician Phone Number:
* must provide value
Phone number preferred for rapid contact if warranted.
Submitting Healthcare Facility Name:
* must provide value
Healthcare Facility Street Address:
Healthcare Facility City:
Healthcare Facility City or County:
* must provide value
Accomack County Albemarle County Alexandria Alleghany County Amelia County Amherst County Appomattox County Arlington Augusta County Bath County Bedford City Bedford County Bland County Botetourt County Bristol Brunswick County Buchanan County Buckingham County Buena Vista Campbell County Caroline County Carroll County Charles City County Charlotte County Charlottesville Chesapeake Chesterfield County Clarke County Clifton Forge Colonial Heights Covington Craig County Culpeper County Cumberland County Danville Dickenson County Dinwiddie County Emporia Essex County Fairfax City Fairfax County Falls Church Fauquier County Floyd County Fluvanna County Franklin City Franklin County Frederick County Fredericksburg Galax Giles County Gloucester County Goochland County Grayson County Greene County Greensville County Halifax County Hampton Hanover County Harrisonburg Henrico County Henry County Highland County Hopewell Isle of Wight County James City County King and Queen County King George County King William County Lancaster County Lee County Lexington Loudoun County Louisa County Lunenburg County Lynchburg Madison County Manassas Manassas Park Martinsville Mathews County Mecklenburg County Middlesex County Montgomery County Nelson County New Kent County Newport News Norfolk Northampton County Northumberland County Norton Nottoway County Orange County Page County Patrick County Petersburg Pittsylvania County Poquoson Portsmouth Powhatan County Prince Edward County Prince George County Prince William County Pulaski County Radford Rappahannock County Richmond City Richmond County Roanoke City Roanoke County Rockbridge County Rockingham County Russell County Salem Scott County Shenandoah County Smyth County Southampton County Spotsylvania County Stafford County Staunton Suffolk Surry County Sussex County Tazewell County Virginia Beach Warren County Washington County Waynesboro Westmoreland County Williamsburg Winchester Wise County Wythe County York County Other
Alternative Contact Information VDH staff intends to respond to the initial COVID-19 Testing Request within 3 hours during normal business hours daily (9:00AM - 5:00PM, Monday - Sunday). If COVID-19 Testing Request are submitted outside of normal business hours, there may be a delay in the initial response. Please provide an alternative point of contact to discuss this request for testing if you are unable to be contacted.
Alternate Contact Phone Number:
Would you like to add additional contact information:
Yes
No
Alternate Contact Phone Number:
Alternate Contact Phone Number:
Patient Full Name:
* must provide value
Patient Initials:
Please enter First Name and Last Name Initials;
Example: Test Patient, should be entered T. P.
* must provide value
First Initial. Last Initial.
Patient Date of Birth:
* must provide value
Today M-D-Y
View equation
Patient Medical Record Number:
Patient Sex:
* must provide value
Female Male Unknown Other
Patient Street Address:
* must provide value
Patient City/County:
* must provide value
Accomack County Albemarle County Alexandria Alleghany County Amelia County Amherst County Appomattox County Arlington Augusta County Bath County Bedford City Bedford County Bland County Botetourt County Bristol Brunswick County Buchanan County Buckingham County Buena Vista Campbell County Caroline County Carroll County Charles City County Charlotte County Charlottesville Chesapeake Chesterfield County Clarke County Clifton Forge Colonial Heights Covington Craig County Culpeper County Cumberland County Danville Dickenson County Dinwiddie County Emporia Essex County Fairfax City Fairfax County Falls Church Fauquier County Floyd County Fluvanna County Franklin City Franklin County Frederick County Fredericksburg Galax Giles County Gloucester County Goochland County Grayson County Greene County Greensville County Halifax County Hampton Hanover County Harrisonburg Henrico County Henry County Highland County Hopewell Isle of Wight County James City County King and Queen County King George County King William County Lancaster County Lee County Lexington Loudoun County Louisa County Lunenburg County Lynchburg Madison County Manassas Manassas Park Martinsville Mathews County Mecklenburg County Middlesex County Montgomery County Nelson County New Kent County Newport News Norfolk Northampton County Northumberland County Norton Nottoway County Orange County Page County Patrick County Petersburg Pittsylvania County Poquoson Portsmouth Powhatan County Prince Edward County Prince George County Prince William County Pulaski County Radford Rappahannock County Richmond City Richmond County Roanoke City Roanoke County Rockbridge County Rockingham County Russell County Salem Scott County Shenandoah County Smyth County Southampton County Spotsylvania County Stafford County Staunton Suffolk Surry County Sussex County Tazewell County Virginia Beach Warren County Washington County Waynesboro Westmoreland County Williamsburg Winchester Wise County Wythe County York County Other
Note, must select valid choice from list.
Patient Zip Code:
* must provide value
Patient Phone:
* must provide value
Patient Medical Information
Today M-D-Y
Please select all symptoms this person is experiencing:
Check all that apply
If available, indicate this persons highest temperature recorded:
Temperature measured in °F
Click ✓ button in order to complete this request and submit for review. Incomplete requests that are not submitted can not be reviewed for approval.