Registration for BinaxNOW Antigen Testing
You are requesting a BinaxNOW rapid antigen test administered by the Mead School District. Please complete the following registration form for yourself or for your student, to begin the testing process. Facilities administering point-of-care (POC) testing for COVID-19 must report all COVID-19 testing results to the Washington State Department of Health (DOH) and/or Spokane Regional Health District (SRHD). WAC 246-101. These registration questions are required by WADOH.
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Building *
Activity Participating In *
Grade *
Last Name *
First Name *
Middle Initial *
Sex at Birth *
Date of Birth *
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/
DD
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YYYY
Age *
Affiliation to Facility *
Address *
City *
State *
ZIP Code *
County *
Phone Number *
Are you pregnant? *
Did you have symptoms of COVID-19 at the time of testing? *
Patient Race *
Specify other race
Patient Ethnicity *
COVID-19 diagnosed in the last 90 days? *
Have You Received A COVID-19 Vaccine
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Exposed to a COVID positive person in the last 2 weeks?  (Currently a close contact/quarantined?) *
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