Physician Referral for COVID-19 Diagnostic Testing

We cannot test your patient without this provider order and an appointment.

Submit the online referral form below or send a fax referral form to 303.270.2153. If possible, fax a copy of the patient’s insurance card or facesheet and photo identification to 303.270.2153.

Patients will be contacted for registration and scheduling. Patients MUST bring their photo identification and insurance (if available) and will sign consent upon arrival.

Note: Antibody testing (IgG and IgM) is generally not appropriate for acutely ill patients. Patients referred for antibody testing who have had new or worsening fever, cough, or shortness of breath within the last 2 weeks may be offered only the molecular diagnostic (swab) test and not the antibody test.

Provider Information

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Patient Information

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Provider Acknowledgment / Electronic Signature

By typing your initials below, you attest that:

  • You are a physician or advanced practice provider with a valid and active license in the State of Colorado.
  • This patient does not require hospitalization.
  • Based on this patient’s signs/symptoms and exposure history, you believe COVID-19 diagnostic testing is clinically indicated.
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