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KDHE Home - Health - BDCP - HIV/AIDS Program - - Orasure/Rapid Test Device Request Form

Orasure/Rapid Test Device Request Form

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Orasure/Rapid Test Device Request Form

Kansas HIV/AIDS Program

All Test requests are completed in the order in which they are received. Please allow up to a week for processing.

* Denotes required fields.


* Note -  In order to submit a request for these records online a FAX number or email address is necessary.


 Comments or Questions:



( * At least one selection below is required before submittal. )

* Select the ones that apply to you: My facility administers  HIV testing through...




Questions: Contact Jamie Flemming at (785) 296-6545 or Fax: (785) 296-4197.