PCR Testing Application · Starter Portal

Organization Information

Which of the following best describes your organization?

Select your organization type from the drop down.

Per current CDPH recommendations, schools are not eligible to register for PCR testing as a primary modality. Please register for professional antigen testing instead.

Please Specify

District Name

K-12 schools in Los Angeles County have been allocated funding through the Los Angeles County Department of Public Health to support in-school COVID-19 testing programs. The Los Angeles County Department of Public Health is collaborating with the Los Angeles County Office of Education and its partners to support COVID-19 testing programs for schools located within the county.

For additional information, please contact your organization’s designated point of contact below:

Public Schools: Dr. Janice Phelps (Phelps_Janice@lacoe.edu) or Ms. Rocio Ortiz (Ortiz_Rocio@lacoe.edu), Los Angeles County Office of Education

Charter Schools: Dr. Delia Castillo (Castillo_Delia@lacoe.edu), Los Angeles County Office of Education

Private Schools: Ms. Katherine Churchwell (schooltestingsupport@pgm.helunahealth.org), Heluna Health

If your organization has already contacted the designated point of contact listed above and has confirmed with your contact that participating in the CDPH VBL K-12 PCR Testing Program is the best option for your organization, please confirm the information below to proceed with your application.

*By checking this checkbox, I confirm that my organization has contacted my designated point of contact for Los Angeles County schools and that the contact is aware that my organization will be submitting an application to participate in the CDPH VBL K-12 PCR Testing Program.

All districts and schools located in Los Angeles County that are participating in the CDPH VBL K-12 PCR Testing Program will be billed for all PCR tests conducted at the standard rate of $21.00 per PCR test.

*By checking this checkbox, I confirm that my organization acknowledges that for all PCR tests conducted at my organization’s testing sites located within Los Angeles County, my organization will be billed at the standard rate of $21.00 per PCR test.

Organization Name

Provide full name, only list single organization. Site-level questions to follow.

Organization Point of Contact Name

Email Address

Phone Number

Please provide the name and email address of an organization representative that will sign the Memorandum of Understanding with the state

MOU Signer Name

Email Address

Are you representing an LHJ signing up as an outbreak team/site?

Local Health Jurisdiction (LHJ) Outbreak teams are typically representatives of the County Department of Public Health.

NoYes

Please confirm your understanding of the following:

I understand our organization cannot charge patients for COVID-19 testing performed through this program

I understand our organization cannot bill patients' insurance for COVID-19 testing performed through this program*

CDPH and/or processing lab will not charge patients but MAY seek insurance reimbursement.