Upload Your Antigen Lateral Flow Test "*" indicates required fields 1How It Works2Find Your Test3Sample Info4Address5Personal Info6Upload Result HiddenTest Type How It Works – Read Guidance Before Uploading Test Result This form is to be used to register and upload the result of lateral flow tests taken on Day 2. A doctor’s signed certificate will be provided. You are required to add either the QR code numbers or the unique test kit number into the field provided. Take a photo of the test cassette along with your passport and upload for verification. The result will be verified by our control officers and a test certificate signed by a qualified medical professional sent usually within 6 hours, when submitted between 9am to 8pm and 12 hours or less if submitted after 8pm.. Please dispose of your swab and tube carefully in the plastic waste bag provided and wash your hands. Watch the video on how to take a lateral flow test. https://youtu.be/zCqo7MhQT6U What is required to upload a test result successfully: Test cassette Form of ID (Example: International passport) Card with the Unique Test Kit Number Booking Reference number for the PLF Result Interpretation Negative result: one line next to C shows the test is negative. Positive result: 2 lines, one next to C and one next to T, even faint lines, shows the test is positive. You or your test provider must report this test to the NHS. Void: no lines, or one line next to T, means the test is void. You will need to re-take with a fresh test kit. Please enter your booking reference number which starts with ACMED or Order Number, whichever applies** This can be found in the invoice that was attached to your order confirmation email. The booking reference you enter is invalid. Please enter the correct booking reference to proceed. Test Kit QR Code (Optional)Use the camera icon below to scan the QR code on the lateral flow test device to populate the box. If unsuccessful, use a scanner app to scan, copy and paste the numbers into the box. Unique Test Kit Number*Type in the Unique Test Kit Number on the card provided. Date Sample Taken* DD slash MM slash YYYY Time Sample Taken* Hour : Minute Note that “time” is in 24-hour format and it is Local Time. Home Address (UK)* Address Line 1 Address Line 2 City County Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Isolation Address (if different from the home address) Address Line 1 Address Line 2 City County Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Traveller Name* First Name Last Name Email* Telephone Number* Sex*MaleFemaleUnknownDate of Birth* DD slash MM slash YYYY Ethnicity*BangladeshiBlack – AfricanBlack – CaribbeanBlack – OtherChineseIndianPakistaniWhiteWhite and AsianWhite and Black AfricanWhite and Black CaribbeanWhite BritishWhite IrishWhite OtherIsc – UnspecifiedAny Other Ethnic CategoryAny Other Mixed GroupOther / MixedUnknownHiddenBooking Reference #* Vaccination Status*YesNoType of Vaccine*Oxford/AstraZenecaPfizer/BioNTechModernaJohnson & Johnson/JanssenCovishieldOtherNHS Number (if applicable) Please take a photo of the lateral flow device along with your international passport and upload here. Please ensure the lines are clearly visible and the photo is not blurred to avoid rejection. See sample below. Upload a photo of your Lateral Flow Test Result* Drop files here or Select files Max. file size: 16 MB, Max. files: 1. HiddenSARS-CoV 2 Rapid Antigen Test Result NEGATIVE POSITIVE UNCLEAR PDF Footer 1Clinical Performance of above LFT: Accuracy 98.8%, Sensitivity 97.1%, Specificity 99.5%PDF Footer 2AC Medical Diagnostics – Tyneside Auto Parc, Sandy Lane Ind. Est., Sandy Lane, Newcastle, NE13 6PETest ManufacturerACON BiotechTest AuthorisationCE Marked IVD in accordance with Directive 98/79/EC Passed assessment and validation by Public Health EnglandHiddenDoes Record of Purchase Exist? Yes No HiddenType of Specimen HiddenType of Test (optional) HiddenTest Method Used HiddenReason the Test Was Performed
