K-12 schools requesting tests from the state are required to complete this form.  We will process your request in the order it was received and the shipping point of contact will be contacted once delivery details are finalized.

Please note:  We are only able to ship tests to a single location for a school district.  If you are an Educational Service Center requesting tests for multiple schools or districts, you will need to complete a separate request for each school or district receiving tests. 

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* 1. Name of District/School

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* 2. Type of School

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* 3. What is your school's IRN number from the Ohio Department of Education?

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* 4. Your Name

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* 5. Your Email Address

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* 6. Your Phone Number XXX-XXX-XXXX

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* 7. How many total tests do you have on-hand?  Please note, this question is about number of tests, not kits, boxes or cases.

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* 8. The state is able to provide rapid tests that are intended to be used for screening and on-demand situations (i.e., testing symptomatic and exposed students and staff, making tests available before and after breaks, Test to Play, etc.). The state has multiple test types that can be made available for different school-based testing uses.

Un-proctored Over-the-Counter (OTC) Tests
These tests are appropriate for providing to students and staff who are symptomatic; for back-to-school; or any situation where an individual needs a test to make individual decisions, but the school doesn't require a document result.  These tests may come one or two to a kit, are intended for use at home and do not include a proctoring session by eMed.  

Clinical Tests
Testing for athletics and on-site testing of symptomatic students or staff are prime use cases for these tests. These are tests that should be used for on-site administration.  Last year, many partners were hesitant to utilize these tests because of some of the administrative requirements:  But this year, the Ohio Department of Health is able to extend a CLIA waiver to participating schools; and both Abbott (through its NAVICA suite) and the CDC (through SimpleReport) are able to provide free tools for managing testing and reporting results.  You would still be responsible for securing a standing order from a physician and staff to observe the administration of the tests.  

 The State Testing Team is able to assist you with any questions you may have.

Use of these tests must be consistent with regulatory requirements and must adhere to the terms of the Emergency Use Authorization granted by the Food and Drug Administration for each test.

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* 9. What address should we ship the tests to? Please note:  We are only able to ship tests to a single location for a public school district. Please coordinate internally and submit a centralized order. 

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* 10. Who is the shipping point of contact? Please note: For public school districts we are requesting one point of contact for the centralized shipping location. 

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* 11. Delivery hours?

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* 12. Does the shipping location have a dock door/loading dock capabilities?

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* 13. Does the shipping location have a fork lift and/or pallet jack?

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