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COVID-19 EREQ
Patient Information


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Provider Information


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

Virus Detection:

720100 - SARS-CoV-2
720005 - Respiratory Panel

Virus Antibody:

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

DX Code(s):

R05 - Cough
R50.9 - Fever, unspecified
R06.02 - Shortness of breath
Z11.59 - Encounter for screening for other viral diseases
Z03.818 - Encounter for observation for suspected exposure to other biological agents ruled out
Z20.828 - Contact with and (suspected) 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