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Order a Home Test Kit

Patient ID
Order Date
Program Name
Location
Location Identifier
First Name
Middle Initial
Last Name
Address 1
Address 2
City
State
Zip Code
Home Phone
Work Phone
Cell Phone
Home Email
Work Email
Sex (M or F)
Government Issued ID
Date of Birth
Preferred Spoken Language
Preferred Written Language
Date Called
Bar Code on Kit Box
Bar Code on Cassette
Kit Lot
Date Kit Was Shipped
Type of Tests Kit Provides
Order Code/Type of Order
Order Status
Doctor's First Name
Doctor's Last Name
dr_upin
dr_npi
Doctor's License Expiration
icd9_code
hcc_code
Primary Care Provider Name
PCP Address 1
PCP Address 2
PCP Address 3
PCP City
PCP State
PCP Zip
PCP Phone
Custom 1
Custom 2
Custom 3
Custom 4
Custom 5

For program questions, please contact Cynthia Kerans at
360-902-6304 or email KERC235@lni.wa.gov
For website and technical concerns please contact support@worksitewellness.net
Frequently Asked Questions

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