All fields marked with "*" are mandatory to fill
Full name - be sure to indicate in the language indicated in the identity documents (English / Ukrainian / Latin).
Need the guaranteed result in 8 hours in Kyiv or in 24 (36) hours in the regions?
Choose - Coronavirus (SARS-Cov-2), COVID-19, RNA by RT-PCR-qualitative, FTD (urgent)
Home address in Ukraine
If you crossed the state border of Ukraine, select YES mark next to the column "Stay in countries with local transmission Covid-19", choose your country and enter return date / border crossing to transfer information in Ministry of Health of Ukraine for "Action at Home".
Providing pre-analytical stage
Giving conclusion in English
Giving conclusion in English PCR COVID
Home visit from the nurse
¹According to the Executive Order of the Ministry of Health of Ukraine #722 from the 22nd of March 2020 in case of positive COVID-19 test result the Medical Laboratory is obliged to immediately inform the person’s Primary Healthcare Provider for the further case registration and sending the form #058/o to the laboratory center of the Ministry of Health of Ukraine.
The form #058/o/ contains personal data including place of work/study, address, age etc., thus this data is mandatory to be filled in this Questionnaire.