Testing_lab_name Testing_lab_specimen_ID Patient_ID Patient_last_name Patient_first_name

Patient_middle_name Patient_race Patient_DOB Patient_gender Patient_ethnicity

Patient_language Patient_street1 Patient_street2 Patient_city Patient_county
Patient_state Patient_zip_code Patient_home_phone Patient_cell_phone
Ordering_provider_name Ordering_provider_street Ordering_provider_city
Ordering_provider_state Ordering_provider_zip_code Ordering_provider_phone
Ordering_facility_name Order_test_date Test_performed_description Test_performed_code
Test_result_coded Test_result_description Test_result_number Test_date
Date_result_released Specimen_collection_date Specimen_received_date
Specimen_type_description Specimen_type_code Comments First_test
Employed_in_healthcare Symptomatic_for_disease Illness_onset_date Hospitalized
ICU Resident_congregate_setting Pregnant Patient_died Patient_death_date
Test_kit_EUA_ID Test_kit_model_name Test_kit_model_ID Instrument_model_name
Instrument_model_ID Test_kit_instance_ID Instrument_instance_ID
General MDH COVID-19 Test Reporting Spreadsheet
Instructions
R = Required. R field names are marked in yellow.
□ Must always be populated.
RE = Required if data exists. RE field names are marked in pale blue.
□ If the data is available, it must be sent.
□ If the data is unavailable or doe not apply, the field can be left blank.

C(R/X) = Conditional. C(R/X) field names are marked in light green.

□ Depending on the test result description (e.g., positive/detected, negative/undetected, invalid) you will enter t
the test used.

Any field with white letters on a black background can be left blank. (Do not delete the column.)