Unlock hundreds more features
Save your Form to the Dashboard
View and Export Results
Use AI to Create Forms and Analyse Results

Forgot Password?
Get Started
OR
Sign UpLogin With Facebook
Sign UpLogin With Google

COVID-19 Lab Report Form Template

Streamline Your Lab Reporting Process with This Effective Template

Managing COVID-19 lab reports can feel overwhelming, especially when timely results are crucial. This template is designed for healthcare providers who need to efficiently gather and relay vital patient information, ensuring accuracy and expediency. You can enhance your workflow by enabling real-time submissions, improving record-keeping, and making access seamless across devices-tablets, phones, or computers. Plus, the form supports WCAG-aligned labels for inclusive usability. Try using the live template to experience the benefits for yourself.

Use this Template (FREE) Live Preview
Patient full name
Date of birth
Patient email
Patient phone number
Patient ID or MRN (if applicable)
Test type performed
PCR/NAAT
Rapid antigen
Antibody (serology)
Other/Unknown
Specimen source
Nasopharyngeal swab
Nasal swab
Oropharyngeal swab
Saliva
Blood (serum/plasma)
Other/Unknown
Specimen collection date
Laboratory accession number
Result date
Ct value(s) or antigen index (if applicable)
Clinical notes or comments
Test result
Detected (positive)
Not detected (negative)
Inconclusive
Invalid
Are you currently experiencing COVID-19 symptoms?
Yes
No
Symptom onset date (if symptomatic)
COVID-19 vaccination status
Fully vaccinated
Partially vaccinated
Not vaccinated
Prefer not to say
Unknown
Ordering provider name
Ordering facility or clinic name
Laboratory CLIA number
Result communication date
Name of person acknowledging receipt of result
Signature of patient/guardian or authorized representative
Signature date
Has the result been communicated to the patient or guardian?
Yes
No
{"name":"Patient full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Patient full name, Date of birth, Patient email","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}

When to use this form

If you run a lab, clinic, or testing site, use this form to capture specimen details, test method, and results in a format providers and employers accept. It also helps school nurses and HR collect consistent records for return-to-campus or return-to-work decisions. In emergency settings, pair it with the Hospital admission form to speed intake when a patient needs inpatient care. If a patient is cleared to resume duties, attach the Urgent care work release form so supervisors have official documentation. Public health teams can also use this record during outbreak investigations to match cases and dates. The outcome: fewer follow-up calls, faster clearance, and a reliable audit trail.

Must Ask COVID-19 Lab Report Questions

  1. What is the specimen collection date and time?

    This anchors the result to a clear timeline and reduces disputes about when the sample was taken. It guides isolation periods and eligibility for retesting or procedures.

  2. What is the patient's full name, date of birth, and a unique identifier?

    Precise identifiers prevent mix-ups and help you match results to the right chart or claim. They also speed coordination with ordering providers and public health.

  3. What test type and assay were used (PCR/NAAT or antigen, with manufacturer)?

    Knowing the method and brand clarifies sensitivity and acceptable use, such as clinical diagnosis versus screening. For travel rules that specify test types, reference your organization's Public health travel declaration form.

  4. What is the result, including units or Ct value if PCR, and the reference range?

    Reporting "detected" or "not detected" alongside reference ranges avoids confusion and supports medical review. If the outcome is negative, you can streamline next steps with the Negative COVID-19 test reporting form.

  5. What clinical context applies (symptoms, exposure, return-to-work, or pre-procedure)?

    Context explains why testing occurred and informs isolation advice or scheduling. It also helps your team prioritize follow-up and documentation requirements.

More Forms

Copy/Edit Form Send to Recipients Make a Form w/AI Form Builder Must Ask Questions
  • 100% Free - No Catches
  • Collect Responses Today
  • Tailor to your Look & Feel