Schedule covid-19 test   |    vaccine  |   Travel Health      0
Schedule covid-19 test   |    vaccine  |   Travel Health      0
Schedule covid-19 test   |    vaccine  |   Travel Health      0
0           âœ†214-613-2019

PRIME CARE HEALTH SOLUTIONS WELLNESS CENTER

COVID 19 TESTING

Your First Name
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Your E-mail Address
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Your Phonenumber
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Your Last Name
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Your Address
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Select a date
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Testing Location Options
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Select Covid Testing Desired
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Description: Fees include: mileage, convenience & administrative fees
From:
From
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Destination:
Destination
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Enter your destination
Distance:
Your Miles
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Costs:
$0.00
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Select Covid Testing Desired
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Symptoms - Please confirm that you do not have symptoms or select the category that most accurately describes your symptoms. *

If you are experiencing Mild and Severe symptoms, select the severe category. If you are symptomatic or you have known or suspected exposure, please schedule your appointment time to take place within 5-7 days of onset of symptoms or exposure.
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  • I have a fever of 102 F or higher

  • I have a fever that has lasted more than 48 hours

  • I am having severe coughing spells or I am coughing up blood

  • I cannot speak full sentences or do simple activities without feeling short of breath

  • My lips or face are blue

  • I have severe and constant pain in my chest

  • I feel dizzy, lightheaded, or too weak to stand

  • I feel very tired or lethargic

  • I am having slurred speech or seizures

  • I do not feel I can stay at home because I feel seriously ill



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  • I have a fever between 100.4 F - 102 F, am feeling feverish or feel warm to the touch

  • I have a new or worsening cough

  • I have a new or worsening sore throat

  • I am having flu-like symptoms (chills, runny/stuffy nose, body aches, feeling tired)

  • My lips or face are blue

  • I am having shortness of breath that is not limiting my ability to speak

  • I have a new loss of taste or smell




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Payment Method

Do you have Insurance?
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Name of Insurance
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Insurance Plan ID
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Primary Insurer first and last name
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Primary Insurer DOB
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Provide first and last name as listed on government/state issued ID
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First_Name
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Last name
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Driver’s License# or Social security
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Address
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Are you 18 years of age or older?
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Which of the following applies to you
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Is this your first COVID-19 test for active infection
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Exposure Please confirm that you do not believe you have been exposed or select the category that most accurately describes your level of exposure *

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  • Had close contact to someone who has recently been diagnosed with COVID-19. Close contact is defined as being within 6 feet of an individual for 10 minutes or more within a 24-hour period, starting from 2 days before their symptoms developed or if asymptomatic, 2 days before they were tested. Close contact does not include individuals who work in a healthcare setting wearing appropriate, required personal protective equipment

  • Received a positive antigen test result within the last 10 days

  • Been informed that they are a part of a positive pod in a surveillance program within the past 10 days




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Are you requesting this testing for a back to work or back to school program
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Proximity - Do you live or work in close proximity with other people? (e.g., a homeless shelter, assisted living facility, group home, prison, detention center, school, or workplace)
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Are you requesting testing for non-medical reason for Travel
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Race
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Ethnicity
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Pregnancy status
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If you are seriously ill, please seek immediate medical care from a healthcare professional. If you are having a medical emergency, please call 9-1-1. Signs of a serious medical condition include, but are not limited to, severe shortness of breath or difficulty breathing, coughing up blood, chest pain, irregular heartbeat, persistent vomiting, or diarrhea.

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