Cue Health MPOX Test Application

Thank you for your interest in the Cue Health Mpox test. Please complete this form to be considered to receive a Cue Health Starter Kit - including 10 Mpox tests and one reusable Cue Health Monitoring System (Cue Reader). Cue Health staff will be available for technical assistance during the trial period. All supplies are subject to availability of stock. 

Cue Health’s nucleic acid amplification test (NAAT) for Mpox received the FDA's Emergency Use Authorization (EUA) for professional point-of-care settings. The Cue Mpox (Monkeypox) Molecular Tests run on a Cue Reader, can be performed at any CLIA-waived facility, and delivers results in 25 minutes, significantly expanding access to fast and accurate patient testing.

For any additional questions, please reach out to Cait Shea, senior manager of clinical programs, at cshea@ncsddc.org. 

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* 1. Name of Organization/Agency

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* 2. Contact Name

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* 3. Email

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* 4. Phone Number

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* 5. NCSD Member Type

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* 6. Type of Site

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* 7. Please provide an estimate on number of patients you serve monthly.

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* 8. Please provide a brief the prevalence of MPOX within your clinic, either historically or currently. 

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* 9. Please provide a brief description of current challenges with testing in your jurisdiction and how these test kits will support with capacity.

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* 10. Does your facility have a CLIA Waiver?

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* 11. Please describe the current process for your clinic/site to request MPOX testing. 

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* 12. Is your clinic/site considering piloting these tests to consider for future use? 

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* 13. If you were to receive this donation, what is your plan for long term sustainability (i.e. funding, potential future use of the product)?

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* 14. With what you have learned about the Cue Health MPOX tests, please describe how these tests would transition into your clinic workflow.

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* 15. With what you have learned about the Cue Health App, please describe what mobile devices or tablets you plan to use for this testing.

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* 16. What is your projected volume of testing with this product per month?

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* 17. What other tests would be useful to your site in utilizing the Cue Health Monitoring System? Please select all that apply. Please note that this is not an endorsement of Cue Health's respiratory test menu, and includes tests that are subject to completion of development and may require regulatory authorization, clearance, or approval before they can be commercialized, e.g. Flu and Gonorrhea/Chlamydia.

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* 18. NCSD is looking to collect data based on test usage. Are you agreeable to collect and report basic data information and to return to NCSD upon receipt and use of tests?

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* 19. How did you learn about the Cute Health rapid MPOX pilot project?

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* 20. Please specify the shipping address and name of the person specifically responsible for receiving deliveries and storage.

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* 21. NCSD and Cue Health may want to publish social media posts about this donation. Would it be feasible to promote our partnership with your health department, clinic, or organization?

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* 22. What questions do you have about the Cue Health MPOX rapid test pilot?

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