COVID-19 Testing Requests and Allocations for Long Term Care

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This survey has been closed. Requests for assistance can be made using the following resources:

For assistance with swabbing, lab processing (PCR), and standing orders (PCR and antigen tests) please email the LTC Battle Plan Team seoc.covid.testing@state.mn.us.

To order antigen tests go to: Abbott BinaxNOW Test Request Form (two-week supply) (state.mn.us)

For assistance with testing recommendations in LTC (outbreak testing guidance, for example) contact:

LTC Surveillance Team: Health.LTC.COVID19.MDH@state.mn.us

Testing Request Status

Testing Team

Internal Notes (not seen by submitter; do not share these widely)

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MDH is no longer requesting rosters of residents and staff from facilities conducting outbreak testing. This change does not influence required case and laboratory reporting.

If you have questions, please email MDH_MN_TestSupport.COVID19@state.mn.us

Are you starting a new cycle of Point Prevalence Survey (PPS) testing?

Definitions: One PPS cycle consists of as many rounds of testing needed to get no new positives.

Another cycle of testing would occur, for example, if a new case has been detected after time has lapsed since the first PPS cycle.

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Yes

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1. Please leave this survey without clicking Submit
2. Reenter the survey link, click on "Returning" and enter your return code. If you need help remembering your return code, please contact the SEOC at seoc.covid.testing@state.mn.us

When did your facility last conduct a facility-wide (staff and residents) Point Prevalence Survey (PPS)?

Never

Within the last 2 weeks

Between 2 weeks and 1 month ago

Greater than 1 month ago

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Please download and complete the attached facility roster.

Minnesota Department of Health (MDH) may use the roster information to ensure all test results are identified; provide technical assistance for post-test interventions; contact positive individuals quickly to collect essential reporting information; initiate contact tracing; and conduct health care worker risk assessment. MDH will also use the information to learn more about COVID-19 in long-term care facilities and to understand the impact of facility-wide testing on disease transmission.

Attachment:Template_pps5roster20210202.xlsx

Upload completed facility roster here

All facilities conducting facility wide testing should submit a roster. This only needs to be done once per testing cycle. You can return to update it if needed.

Upload file

The roster is requested from all facilities conducting facility wide testing, for use by MDH as described above.

For facilities receiving state testing support, upload of the roster is required prior to scheduling.

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I acknowledge I will return and upload this roster if not completed today and that my facility cannot be scheduled until this is completed.

Facility Type

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**Other type of facility was selected, please specify (e.g. chemical dependency, home health agency, group home, foster care etc.)

Facility Name

Skilled Nursing Facility Name and HFID Number

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Assisted Living Facility Name and HFID Number

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Other Facility Name

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Combined HFID

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Facility ID

Click HERE to find your Facility ID

Other Facility ID

Facility Street Address

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Facility City

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Facility County

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Facility Zipcode

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Facility Point of Contact Name

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Facility Point of Contact Phone Number

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Facility Point of Contact Email

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Health Care Coalitions
Click HERE to find your coalition

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Reason for completing this survey

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Swab Team Needed (e.g. Mayo Health System, MNNG etc.)

Only Lab Supplies Needed (i.e. doing our own testing, no swab team needed)

Informing about facility-wide testing, no State support needed

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Reason for Testing

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Conducting PPS Testing (facility wide testing due to +case or symptomatic staff/resident)

Conducting routine, non-outbreak staff testing only

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Because you are conducting routine staff testing, you may not need to continue filling out this survey. Only continue if you are requesting testing support (e.g. swab team or supplies).

Reason for completing this survey

Date you would like to or plan to start testing

Please note we will do our best to meet your timeline.

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M-D-Y

Total number of tests you intend to conduct

Risk Assessment (select all that apply)

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Minimum 1 staff member or resident with positive COVID test within the last 14 days

Two or more newly symptomatic staff and/or residents in separate portions of the facility within 72 hours, where staff are not shared

Two or more newly symptomatic staff and/or residents in any areas where staff are shared

No known COVID-19 cases in residents and/or staff at this time

Facility identified by MDH or LPH as an outbreak facility for priority testing

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Total Weight

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Total number of staff

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Current number of COVID-19 Symptomatic Staff

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Of the ______ total staff in your agency, how many need to be tested

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Total number of residents

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Current number of COVID-19 Symptomatic Residents

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Of the ______ total residents in your agency, how many need to be tested

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Total Number of Tests

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What is the primary Health System affiliation of the facility/resident?

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What percent of your residents are affiliated with the above Health System?

Are you in need of a mobile testing team? (e.g. MN National Guard)

Yes

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Testing materials needed/required? (e.g. swabs)

If a facility already works with a laboratory, they should continue to work with that laboratory to obtain supplies and schedule testing. If the regular laboratory does not have capacity for testing, or if a facility does not have an existing relationship with a laboratory, the laboratories in the table below have indicated that facilities can reach out to them directly to arrange for supplies and specimen testing. Please note that some labs may need time to set up a new account for you; if this presents problems, please contact the State Emergency Operations Center (SEOC) at seoc.covid.testing@state.mn.us for assistance.

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Yes

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Have you contacted the labs below without success?

Laboratory Name	Point of Contact	Phone or Email
Allina	Heather Dawson	763-742-8713
Centra Care	Cindy Johnson	320-223-8376
Essentia	N/A	833-933-0505
Glacial Ridge Health System	Kathy Christianson	320-634-2257
Health Partners	Rick Panning	651-280-5909
Hennepin Healthcare	Pearl Peoples-Swearingen	612-309-9662 or laboutreach@hcmed.org
Mayo Clinic Laboratories	N/A	1-800-533-1710 or MCL@mayo.edu
North Memorial	Patti Smith	651-341-0756
Ridgeview Medical Center	Dean Porter	612-219-8055
Solaris Diagnostics	N/A	Admin@solarisdx.com
University of Minnesota	Sophia Yohe	612-834-5489

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Yes

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Please contact the labs provided above for assistance. A list including both phone numbers and email addresses can be found in the Serial Testing of Nursing Facility Staff for COVID-19: Frequently Asked Questions on page 2 of 10.

Which lab(s) have you contacted and what, if any, were the issues?

Please note that all commercial labs need time to onboard a new facility into their system.

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Number of Testing Kits Needed

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Copan Nasal Swab

Puritan Sterile Foam Tipped Applicators

Puritan Sterile Flocked Collection Devices

Transport Medium

Transport Packaging

Yes

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If you require Thermometers or PPE such as, N95, Gloves, Eye Protection, etc. please CLICK HERE

Additional needs, please specify

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Testing Contractor Name

Testing Contractor Phone Number

Name of Lab where tests were submitted to

Lab Point of Contact name

Is there any additional information you would like to share?

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Have you completed any testing at your facility to date?

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Yes

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Have you completed your initial testing (baseline) of staff and/or residents?

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Yes

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Date Baseline test scheduled/completed at facility

M-D-Y

Total Staff Tested

Total Positive Staff

Total Resident Tested

Total Positive Residents

After receiving test results from this round of testing, which of the follow occured at your facility?

Select all that apply.

All new positive residents were moved into a dedicated COVID-19 unit(s).

Transmission-based Precautions used when treating, delivering meals, or cleaning rooms of COVID-19-positive residents.

Solutions were identified for residents who do not comply with room isolation, to ensure social distancing is maintained.

Staff working on the COVID-19 unit, or with COVID-19-positive residents, did not work with any other residents.

Asymptomatic staff positive for COVID-19 were excluded from work.

An observation unit is used for new admissions and re-admissions.

New admissions were put on hold.

A test-based approach is used to release residents from Transmission-based Precautions.

A time- and symptom-based approach is used to release residents from Transmission-based Precautions.

Per testing recommendations, will you conduct another round of testing?

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Yes

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Have you completed your 7 day follow up testing of staff and/or residents?

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Yes

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Date 7 day follow up test scheduled/completed at facility

M-D-Y

Total Staff Tested

Total Positive Staff

Total Residents Tested

Total Positive Residents

After receiving test results from this round of testing, which of the follow occured at your facility?

Select all that apply.

All new positive residents were moved into a dedicated COVID-19 unit(s).

Transmission-based Precautions used when treating, delivering meals, or cleaning rooms of COVID-19-positive residents.

Solutions were identified for residents who do not comply with room isolation, to ensure social distancing is maintained.

Staff working on the COVID-19 unit, or with COVID-19-positive residents, did not work with any other residents.

Asymptomatic staff positive for COVID-19 were excluded from work.

An observation unit is used for new admissions and re-admissions.

New admissions were put on hold.

A test-based approach is used to release residents from Transmission-based Precautions.

A time- and symptom-based approach is used to release residents from Transmission-based Precautions.

Have you completed your 14 day follow up testing of staff and/or residents?

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Yes

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Date 14 day follow up test scheduled/completed at facility

M-D-Y

Total Staff Tested

Total Positive Staff

Total Residents Tested

Total Positive Residents

After receiving test results from this round of testing, which of the follow occured at your facility?

Select all that apply.

All new positive residents were moved into a dedicated COVID-19 unit(s).

Transmission-based Precautions used when treating, delivering meals, or cleaning rooms of COVID-19-positive residents.

Solutions were identified for residents who do not comply with room isolation, to ensure social distancing is maintained.

Staff working on the COVID-19 unit, or with COVID-19-positive residents, did not work with any other residents.

Asymptomatic staff positive for COVID-19 were excluded from work.

An observation unit is used for new admissions and re-admissions.

New admissions were put on hold.

A test-based approach is used to release residents from Transmission-based Precautions.

A time- and symptom-based approach is used to release residents from Transmission-based Precautions.

Have you completed additional testing (more than 3 rounds)?

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Yes

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Please Report any additional testing here:

If easier, you may upload a file below.

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Additional Testing Reporting

Upload file

LTC Battle Plan team sent testing template and webinar to provider

Yes

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First consult session

M-D-Y H:M

Second consult session

M-D-Y H:M

Third consult session

M-D-Y H:M

Session notes/updates

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most updated plan draft

Upload file

M-D-Y

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