Wisconsin COVID-19 Collection Supplies Request

This website is for healthcare providers only. If you are an individual experiencing COVID-19 symptoms, please visit wihealthconnect.com for more information and COVID-19 screening.

Wisconsin COVID-19 Collection Supplies Request

Instructions

FOR IMMEDIATE OUTBREAKS CONTACT YOUR LOCAL HEALTH DEPARTMENT

The following supplies and services to facilitate laboratory COVID-19 testing are available at no charge to qualifying Wisconsin clinicians, local and tribal health centers, clinical laboratories, skilled nursing facilities, and other approved entities collecting specimens in response to COVID-19. The supplies and laboratory services are intended for the purpose of expanding Wisconsin’s existing COVID-19 testing capacity. Please do not use these supplies and services for the purpose of replacing your own existing testing resources. You may not bill third-party payors for these supplies and services (for more information about billing, click here).

Room Temperature Collection Kits: Specimen collection materials including viral transport media (VTM) and a nasopharyngeal (NP) swab. Room temperature storage. Collection Instructions
Refrigerated Collection Kits: Specimen collection materials including VTM and NP swab. NOTE: May be shipped and stored for up to 6 weeks at room temperature, or stored refrigerated (2°- 8° C) for up to 12 months. Package Insert Collection Instructions
Exact Sciences Collection Supplies and Laboratory Services: Specimen collection materials including saline and a nasal swab. Room temperature storage. NOTE: Supplies intended for testing performed by Exact Sciences at no charge. For collection instructions and additional information go to: Exact Sciences
Swab Only: NP swab alone, FDA approved.
VTM Only: CDC protocol VTM. NOTE: May be shipped and stored for up to one month at room temperature, or stored refrigerated (2°- 8° C) for up to 12 months. Package Insert
Small Category B Return Shipping Materials: Insulated cooler with category B labels, 2 cool paks, and packing material. Can hold up to 40 collected specimens.
Large Category B Return Shipping Materials: Insulated cooler with category B labels, 4 cool paks, and packing material. Can hold up to 200 collected specimens.

The supplies and laboratory services are intended for the purpose of expanding Wisconsin’s existing COVID-19 testing capacity. The supplies and laboratory services are available for testing symptomatic and asymptomatic individuals based on clinical guidelines established by the organization requesting the materials.

Demographics - Please compete these questions to continue the request

Enter the number of patient COVID-19 tests your facility has initiated in the past 7 days (enter 0 if none) Must be 0 or greater to continue

In order to help us prioritize your request, please describe your planned use of the collection materials

Please state which clinical laboratory will perform testing of specimens collected with the requested materials

Healthcare Facility Type

To allow us to better track the distribution of testing supplies among the various types of health care providers in the State, please select from the provided drop down menu the type of health care facility that best describes on whose behalf you are placing your order. If you are requesting supplies on behalf of a county jail or medical examiner, please route your request to your County Public Health Department instead of this website.

Requester Contact Information

Enter your contact information, including your direct line phone number, to avoid delays should we need to contact you regarding details for your order.

Prefix

First Name

Last Name

Phone Number

Company or Organization

Address

Address 2

City

County

State

Zip Code

Shipping Information

Be sure to fill an appropriate shipping address (no PO Box address). Provide the name and phone number for the staff member responsible for receiving the shipment.

Prefix

First Name

Last Name

Company or Organization

Attention

Shipping Attention Phone Number

Address

Address 2

City

County

State

Zip Code

Testing Supplies

We will make every effort to send health care providers their preferred specimen collection materials. However, in the event that demand for particular materials exceeds current supply, we will send providers alternative materials if they can be utilized. If you have the ability to use more than one of the three types of collection materials, please select each type of materials you can use and prioritize those from 1 to 5, with 1 being your first choice. Priority is not required for "Small Category B Return Shipping Materials" and "Large Category B Return Shipping Materials".

Supplies

Priority Priority must be unique

14 Day Needs How many do you need for the next 14 days?

Requested Supplies

Please add items to your list using the fields above.

Notes

Notes or Comments (500 character max)

Acknowledgement

You agree that your organization will not bill patients or other payors for the supplies and services it receives from the State as a result of the request placed via this website.

Contact Information
Email: WICOVID19TestingCollectionSupplies@wisconsin.gov