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COVID-19 EREQ
Patient Information


Insurance Type

Attestation

We attest that the user attempted to capture the Social Security Number or state identification/driver's license number and the patient did not have this information at the time of service or we did not have direct contact with the patient and thus did not have the opportunity to attempt to capture this information.


Provider Information


COVID-19 Tests  Select the order code(s) for this requisition

Virus Detection:

720100 - SARS-CoV-2
720005 - Respiratory Panel
720015 - SARS-CoV-2 + Influenza A and B (COVFLU19)
720020 - SARS-CoV-2 (SALIVA)

Virus Antibody:

423050 - SARS-CoV-2 IgG
423046 - SARS-CoV-2 IgM
423048 - SARS-CoV-2 IgG and IgM

DX Codes:

R05 - Cough
R06.02 - Shortness of breath
R50.9 - Fever, unspecified
Z03.818 - Possible exposure
Z11.52 - Encounter for screening for COVID-19
Z20.822 - Contact with and (suspected) exposure to COVID-19
Z20.828 - Contact with exposure to other viral communicable diseases


Custom State Required Questions
According to the CDC:
People with COVID-19 have had a wide range of symptoms reported - ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:
  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

Allow us to text you when results are ready

You agree that Mako may send automated messages to the phone number you provided above. Messages may include limited health information that will not be encrypted, which you understand may pose some security risk. We do not charge for these notifications, but your carrier’s message and data rates may apply. Participation is not required in order to receive services.