COVID -19 Sample Collection Form

Patient Name *

Father/ Husband Name *

Age *

CNIC (Without Space) *

Address *

Gender *

Male

Female

Phone *

Recent Travelling History (Mention place) *

H/O cough *

H/O Fever *

H/O Shortness Of Breath *

H/O Close contact with COVID patient *

H/O last hospital Visit *

H/O Previous COVID testing( If Performed ) And its result( Positive/Negative ) *

Any Other reason of testing ,Travelling, Job requirement etc. *

H/O Previous COVID testing( If Performed ) And its result( Positive/Negative ) *

Any Other reason of testing ,Travelling, Job requirement etc. *

Lab ID *

Date of Specimen collection *

Type of Sample

Nasopharyngeal *

Oral *

Blood *

Test Required

PCR( Gene detection) *

ICT( Antibodies ) *

ICT( Antigen detection ) *

PCR( Gene detection) *

ICT( Antibodies ) *

Medipharma now available at :

The Capital Diagnostic Centre (CDC) is a well-known diagnostic centre in the capital territory providing diagnostic facilities to national and international organizations for several years.

For Info & Appointment 03155159616

COVID -19 Sample Collection Form