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* 1. Facility Name

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* 2. Facility State ID Number
(Format: X000000, e.g., N103103)

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* 3. Facility Address

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* 4. County

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* 5. Name of lab that is either processing your COVID-19 tests or is supplying your facility with COVID-19 tests

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* 6. Are you currently conducting regular testing of staff?

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* 7. I would like to change my testing status to

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* 8. I would like to request a non testing status change (e.g., facility name change, facility address change, etc.)

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* 9. Any other comments or updates for the report?

0 of 9 answered
 

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