TESTING

SECTION 1: TESTING OPTIONS

What test would you like to receive?

ALL TESTS ARE CLIA APPROVED

Influenza:

Scott Pharmacy has started providing necessary influenza test to patients in a safe and convenient setting in order to ensure appropriate and timely antiviral therapy is started for patients with a poistive influenza test.

IMPORTANT INFO

If positive, to be eligible for influenza treatment:

Must be 6 years or older
Must have flu-like symptoms
Onset of symptoms within the last 48 hours

List of treatment exclusion criteria on bottom of form

Strep Throat

Scott Pharmacy has started providing necessary strep test to patients in a safe and convenient setting in orderto ensure appropriate antibiotic therapy is started for patients with a poistive Group A Streptococcal strep throat test.

IMPORTANT INFO

If positive, to be eligible for strep throat treatment:

Must be 6 years or older
Must have strep throat symptoms
Onset of symptoms within the last 48 hours

List of treatment exclusion criteria on bottom of form

SECTION 2: DEMOGRAPHICS

Name:

First NameLast Name

Date of Birth:

Phone Number:

Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState

Zip Code

Gender:

Email

example@example.com

SECTION 3: SCHEDULING

Appointment

SECTION 4: IMPORTANT INFORMATION

All testing will be in the Scott Pharmacy parking lot. Unfortunately these tests are not covered by insurances. The pharmacy can accept cash or credit card for payment at the time of the appointment. For rapid antigen testing and rapid PCR the pharmacy will provide a printed confirmation of the results.

DISCLAIMER: Please understand that no third-party reimbursement, including Medicare or Medicaid reimbursement, will be submitted for this test. There are other testing locations which offer free tests, and testing which is covered by Medicare and Medicaid. However, at this location, no third-party reimbursement will be sought, and the above patient agrees to pay out of pocket for the cost of the test.

FLU TREATMENT EXCLUSIONS: Immunocompromised, taking steroid for longer than 2 weeks, been prescribed an antiviral for influenza in the last 14 days, have a medical condition that requires supplemental oxygen therapy, known hyersensitivity to tamiflu/xofluza, women who are pregnant or breastfeeding, and/or patients less than 19 who are on long-term aspirin therapy.

STREP TREATMENT EXCLUSIONS: Immunocompromised, taking steroid for longer than 2 weeks, been prescribed an antibiotic for sore throat/respiratory infection in the last 30 days, have a medical history of rheumatic fever/rheumatic heart disease/scarlet fever/GAS-inducted glomerulonephritis, known hyersensitivity to certain antibiotics (amoxicillin/cephalexin), and women who are pregnant or breastfeeding.