COVID-19 Test Form PDF in English, Hindi

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This COVID-19 Test Form is for collection centers/ labs to enter details of the samples being tested for Covid-19. It is mandatory to fill this form for each and every sample being tested. It is essential that the collection centers/ labs exercise caution to ensure that correct information is captured in the form.

In this article, we’ll provide you COVID-19 Test Form PDF in English Format, available to download from the official website at or download using the direct link below.

Here You Download COVID-19 Test Form PDF in English

  • Category:  Government
  • Format: PDF
  • Size: 0.23 MB
  • Pages: 2
  • Source:
  • Language: English
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Also read | List of Comorbidities for COVID Vaccine India PDF

COVID-19 Test Form

ICMR Specimen Referral Form for COVID-19 (SARS-CoV2)


● Inform the local / district/state health authorities, especially surveillance officer for further guidance
● Seek guidance on requirements for the clinical specimen collection and transport from the nodal officer
● This form may be filled in and shared with the IDSP and forwarded to a lab where testing is planned

COVID-19 affects different people in different ways. Most infected people will develop mild to moderate illness and recover without hospitalization.

  • fever
  • dry cough
  • Tiredness

Less common symptoms:

  • aches and pains
  • sore throat
  • diarrhea
  • conjunctivitis
  • headache
  • loss of taste or smell
  • a rash on the skin, or discoloration of fingers or toes

Details to be Mentioned in COVID-19 Test Form

  • Patient Personal Details
  • Specimen Information Form Referring Agency
  • patient Category
  • Medical Information
  • Hospitalization Details
  • And any other details.

Download the COVID-19 Test Form in PDF format using the link given above.

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