KDHE COVID-19 POC Test Confirmation Form

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Please fill out the following form to confirm your shipment of GenBody COVID-19 point of care tests. The deadline to complete this form is May 26, 2022.

You will receive your tests over two shipments. A list of test allocations for each facility was attached to the message you received.

Note: There are 25 tests per box and 36 boxes per case, for a total of 900 tests per case. Cases measure 22" x 15.5" x 21"

Email *

Facility Name *

Your Name *

Number of COVID-19 boxes you will accept *

Boxes will be shipped directly to your facility. Please refer to the attachment in the message you received for details of your test allocation.

Accept full allocation

Accept a partial allocation

Decline any allocation

If you selected a partial allocation, please list the number of boxes of tests that you are requesting

Please share any additional comments or questions here

A copy of your responses will be emailed to the address you provided.

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