BUILD#329-89

Pre-Registration



(Note: Please use previous transaction reference no. to Search)

Testing Category/Subgroup












Personal Info






Current Address


MUNA Account Detected

Permanent Address




Employment



Current Workplace Address

Travel History




Contact Tracing


List the names of persons who were with you two days prior to onset of illness until this date and their contact numbers. *If asymptomatic,list the names of persons who were with you on the day you submitted specimen for testing until this date and their contact numbers.

Name Contact Number

For Additional Close Contact (Include ALL Household Contacts)

Name Contact Number Exposure Settings (ex. Household, Work)

Consultation and Admission Information



Special Population










Exposure History



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To

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Clinical Info


Signs & Symptoms

Comorbidities

If existing case:

Chest imaging findings suggestive of COVID-19:


Outcome/Condition at Time of Report

Payment


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Pre-Register

Testing Category/Subgroup

Personal Information

Employment

Travel History

Contact Tracing

Consultation and Admission Information

Special Population

Exposure History

Clinical Info

Payment Method

Data Privacy & Recaptcha

DATA PRIVACY CONSENT

In Compliance with the Data Privacy Act (DPA) of 2012 and its Implementing Rules and Regulations (IRR), I am allowing and giving my express consent to Philippine Airport Diagnostic Laboratory (PADLAB) to furnish and provide the details of the results of my PCR/Antigen test, including any and all personal and sensitive personal information I provided to PADLAB in the conduct of my PCR/Antigen test to PADLAB, in accordance with its request dated to PADLAB.
I also acknowledge and warrant that I have given my absolute consent to furnish the result of my PCR/Antigen test, including any and all personal and sensitive personal information I provided to PADLAB in the conduct of my PCR/Antigen test to PADLAB and I hold free and harmless PADLAB from any complaint, suit or damages which any party, including my heirs or assigns, may file or claim in relation to this consent.