Table 2: Table shows Form used in laboratories to be submitted with sample.

Submitter Information
Name of submitting hospital, laboratory or other facility
Phone number
Case definition O Suspected         O Probable case
Patients Information
First Name Last Name
Patients ID number DOB: Age:
Address Sex: Phone number:
Specimen Information
Type of Specimen O Nasopharyngeal and oropharyngeal swab
O Bronchoalveolar lavage
O Endotracheal aspirate
O Nasopharyngeal aspirate
O Nasal wash
O Sputum
O Sputum
O Serum
O lung tissue
O Whole blood
O Stool
Please tick the box if sample taken is postmortem
Clinical details
Date of symptom onset
Has patient has history of travelling to affected area O Yes
O No
O Country:
O Return date:
Has the patient had contact with confirmed cases? O Yes O No O Unknown O Other exposure
Additional information