• Registration Form for Reporting COVID-19 (SARS-CoV-2) Lab Testing Data in Texas


    Who should complete this registration form?

    All laboratories (commercial, hospital, public, or non-traditional testing facilities) who are performing tests for COVID-19 (SARS-CoV-2) in their lab facility must register.

    If you have not already registered with DSHS to submit COVID-19 laboratory results electronically, please complete the questions below. If you are unsure whether you are registered, please send an email to COVID-19ELR@dshs.texas.gov to verify.

    After you submit the below registration form for your facility, you will be contacted within 3-5 business days and receive further instructions on next steps.


    Registration Form

    All fields marked with an asterisk (*) must be completed.

    Submitter Status & Agreement


      
    Facility Information

    7. Address of Reporting Facility

          
          
          
          

    Contact Information

    8. Primary Contact
    The primary contact should be the programmatic or administrative lead. This individual will be contacted if there are questions concerning the facility at large.

          
          
          
          
          

    9. Secondary Contact
    The secondary contact should be the technical lead who will conduct all the technical aspects of the onboarding and reporting process. This person will be contacted if there are issues in data reporting.

          
          
          
          
          

    Interface Details


    (DSHS will contact the Primary Contact at your facility for additional information, which will include the name and CLIA number of all additional facilities.)

    12. EHR Software

          
          
          
          

     


    (If you are a current submitter, select N/A.)

       

       
     


Last updated May 8, 2020