Sample Id: Sample Id: 6284347 Icmr Specimen Referral Form Icmr Specimen Referral Form For For Covid-19 (Sars-Cov2) Covid-19 (Sars-Cov2)
Sample Id: Sample Id: 6284347 Icmr Specimen Referral Form Icmr Specimen Referral Form For For Covid-19 (Sars-Cov2) Covid-19 (Sars-Cov2)
Sample Id: Sample Id: 6284347 Icmr Specimen Referral Form Icmr Specimen Referral Form For For Covid-19 (Sars-Cov2) Covid-19 (Sars-Cov2)
INSTRUCTIONS:
Inform the local / district / state health authorities, especially surveillance o cer for further guidance
Seek guidance on requirements for the clinical specimen collection and transport from nodal o cer
This form may be filled in and shared with the IDSP and forwarded to a lab where testing is planned
Fields marked with asterisk (*) are mandatory to be filled
Symptoms Yes Symptoms Yes Symptoms Yes Symptoms Yes Symptoms Yes
Cough Diarrhoea Vomiting Fever at evaluation Abdominal pain
Breathlessness Nausea Haemoptysis Body ache
Sore throat Chest pain Nasal discharge Sputum
Which of the above mentioned was First Symptom: Date of onset of First Symptom (dd/mm/yy) :0000-00-
00 00:00:00
04-08-2020
11:24:56 AM