BinaxNOW Antigen Testing

Use and Distribution Survey

Del Norte County Public Health is asking the following questions about your office/facility in order to determine how we can use and distribute the new antigen test for COVID-19, BinaxNOW. Please take a few minutes to answer the following questions:

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* 1. Please describe your clinical or service setting, e.g. primary care office, surgical care, ambulance services, school, etc.

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* 2. What is the name of your clinical or service setting?

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* 3. Please list your contact number and address.

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* 4. Do you have a CLIA-waived lab capacity?

Yes

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* 5. Please tell us the highest level of training of the staff that might be asked to conduct a test in your facility, e.g. lab technician, RN, paramedic, etc.

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* 6. Please estimate, based on your current and recent experience, the number of tests that you would likely use in a month:

0-100

100-250

250-300

300-400

400-500

500+

Other (please specify)

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* 7. Please describe the expected use of these tests.

Patients/Clients Only

Staff Only

Patients/Clients and Staff

Other (please specify)

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* 8. Would you have the capacity and willingness to enroll in the California lab reporting system (CalREDIE) to report test results?

Yes

Already enrolled in CalREDIE

Other (please specify)

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* 9. Would you have the capacity and willingness to enroll and utilize NAVICA, the web-based tool to electronically enroll and report to patients and clients who are tested?

Yes

Other (please specify)

BinaxNOW Antigen Testing

Use and Distribution Survey

Question Title

* 1. Please describe your clinical or service setting, e.g. primary care office, surgical care, ambulance services, school, etc.

Question Title

* 2. What is the name of your clinical or service setting?

Question Title

* 3. Please list your contact number and address.

Question Title

* 4. Do you have a CLIA-waived lab capacity?

Question Title

* 5. Please tell us the highest level of training of the staff that might be asked to conduct a test in your facility, e.g. lab technician, RN, paramedic, etc.

Question Title

* 6. Please estimate, based on your current and recent experience, the number of tests that you would likely use in a month:

Question Title

* 7. Please describe the expected use of these tests.

Question Title

* 8. Would you have the capacity and willingness to enroll in the California lab reporting system (CalREDIE) to report test results?

Question Title

* 9. Would you have the capacity and willingness to enroll and utilize NAVICA, the web-based tool to electronically enroll and report to patients and clients who are tested?

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* 10. Please include any other comments or questions you have about BinaxNOW distribution or use.