Long Term Care: COVID 19 Testing Status Report [Status or Update to Info Request]

1.Facility Name(Required.)
2.Facility State ID Number
(Format: X000000, e.g., N103103)
3.Facility Address
4.County(Required.)
5.Name of lab that is either processing your COVID-19 tests or is supplying your facility with COVID-19 tests(Required.)
6.Are you currently conducting regular testing of staff?(Required.)
7.I would like to change my testing status to(Required.)
8.I would like to request a non testing status change (e.g., facility name change, facility address change, etc.)
9.Any other comments or updates for the report?
Current Progress,
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