Alere eScreen® - Clinic Solutions

Clinic ID*

Name (Clinic)*

First / Last Name*

Email Address*

Phone*

Please confirm the following so that your collection facility will be activated for Federal eCCF® via eScreen123®.

Once your facility is prepared and can agree to the requirements below, complete this form. Completion of this form will trigger eScreen to enable your site for Federal eCCF.

I confirm our operators have been trained to perform Federal eCCF collections in eScreen123.*

(See training resources at right)

Yes

I confirm our collection facility currently has the required supplies, barcode labels and blue/white Federal stickers in stock.*

Yes

I confirm that our collection facility is ready for immediate activation to perform Federal eCCF via eScreen123.*

Yes

Send me a copy of my responses

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