Antigen Testing in Schools (Legacy)

California K-12 School Rapid Antigen Testing supports Pasadena, Long Beach, and all other California schools outside of Los Angeles County.* On-campus child cares, afterschool programs and school-related camps may ask their schools for shared at-home tests, or may apply directly to start on-site testing.

*Los Angeles County

excluding the cities of Pasadena and Long Beach

Please do not use this form; email Edith Hernandez: ehernandez3@ph.lacounty.gov for support.

Two types of antigen tests for COVID-19 are available to support student and staff testing in public school districts, charter schools and independent schools. A school may choose to use one or both types of tests.

1. At-home tests:

Adults self-test, children test with parent/guardian.

https://labsupport.powerappsportals.us/orderotc/

2. On-site testing program using CLIA-waived BinaxNOW antigen tests:

People self-swab, site runs the test and reports results.

You will receive an automated email within 2 hours of submitting the form. Please read the email carefully. If you do not receive an automated response, please email schoolbinax@cdph.ca.gov.

Type of Organization

District / COE Name

Organization Name

Check Box to Update Address

Street

Building/Suite (Optional)

City

Zip Code

County

As noted on the form above, Los Angeles County schools/organizations (public, private, and charter) should not use and/or complete this application form except in selected circumstances.

However, if after discussion with both the Los Angeles County Department of Public Health and the School Antigen Testing team, it has been determined that your Los Angeles County-based school/organization should enroll under the CDPH School Antigen Testing Program, please confirm below.

*By checking here, I confirm that my organization wishes to enroll in the CDPH School Antigen Testing Program. I confirm that this has been discussed with Los Angeles County Public Health and the CDPH School Antigen Testing team, and that all parties are in agreement with enrollment in CDPH (rather than Los Angeles County) programming.

Please select the type of tests you are planning to use:

School-Based Antigen Testing (Rapid, On-site Testing using CLIA-waived BinaxNOW Antigen Tests)

Which population segments do you plan to test? Please check all that apply.

CDPH has a statewide CLIA waiver to allow organizations who do not have a CLIA waiver to test.

Do you plan to use the state’s CLIA waiver and ordering physician?

If you are unsure of what this means, please choose yes.

CLIA Number

Do you want to use the reporting platform Primary.Health, provided free of charge by the state, for results reporting and management? This is preferred. If not, you must fill out a monthly report that details the number of samples collected and positive results.

Enter the point of contact for your organization. This should be someone who can receive regular contact about program updates and will be either managing the online testing platform Primary.Health (for schools using the state’s CLIA waiver, and schools using own CLIA and opting to use Primary.Health) or submitting monthly reports.

Org Lead First Name

Org Lead Last Name

Org Lead Email

Please confirm your email address

Org Lead Phone Number

Enter a secondary point of contact for your organization (optional).

Secondary POC First Name

Secondary POC Last Name

Secondary POC Email

Secondary POC Phone

Enter your organization’s point of contact for signing the program Memorandum of Understanding (MOU). This should be your district superintendent or principal. In the confirmation email, you will receive a link to DocuSign to sign the MOU. This confirmation email will also be sent to the email you enter below.

MOU Signer Email Address

This is not a production system. Please use this link for the CDPH Testing Task Force.

https://labsupport.powerappsportals.us/testingprograms

Antigen Testing in Schools (Legacy)

Please select the type of tests you are planning to use:

Which population segments do you plan to test? Please check all that apply.

CDPH has a statewide CLIA waiver to allow organizations who do not have a CLIA waiver to test.

Enter a secondary point of contact for your organization (optional).