Minerva Testing Form

Health Insurance Information
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Insurance Card

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I give conset for a staff member of the Medicine Center Pharmacy to collect and process my sample for test(s) I have selected. This will require a blood sample to be collected by a lancing device on a finger of my choice. If not enough blood is collected, it could require multiple finger pricks.
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My Products*
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Rapid COVID-19 TestAntigen test - results within 15-30 minutes
$35.00



Rapid COVID-19 plus Flu (A/B)Results in 15-20 minutes
$60.00



A1CResults in 5-10 minutes
$35.00



Lipid PanelResults in 10-15 minutes
$35.00



TSH (Thyroid-stimulating hormone)Lab mail off test
$46.00



Total

$0.00
**IMPORTANT** Lab sendoff information

-Your insurance will be billed by Mobility Health Labs so please provide up to date information

-Test results generally available next day but can take longer if there are any unexpected delays

-To get your results faster, you need to make an account with lab BEFORE your appointment. You will be redirected after submitting.

You will only need to create an account once. If you have already made an account for a previous appointment, please skip this step.

If the test is for a minor then a guardian will make an account under his or her name and the child will be added to the account during the appointment.
MCP Staff Use Only - Please go back up to submit
Medicine Center Pharmacy - Minerva

Located at: 251 East St. Minerva, Ohio 44657-1617

CLIA: 36d0960793

NPI: 1295826741

Phone Number: 330-868-6200
Specimen Information:

Collected: {appointmentsminerva}

Test Performed: {appointmentsminerva}

Specimen ID: 1
Test ID - 20387
Provider (Pharmacist)
COVID-19 Result
Flu A/B Result
A1C Test
Result:blank
Lipid Panel
LDL:blank mg/dL
HDL:   Type a label   mg/dL
Total Cholesterol:   Type a label   mg/dL
TRG:   Type a label   mg/dL
NON-HDL:   Type a label   mg/dL
TC/HDL:   Type a label
Glucose:   Type a label   mg/dL
Lot: Lot Exp. Date: Exp.
N/A

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Minerva Medicine Center Pharmacy Testing Appointments

COVID-19 and Flu testing will be done curbside. Please do not enter the pharmacy for these tests. Follow the signs in the parking lot.

SAME DAY APPOINTMENT - Please check with the store to see if they are able to accommodate your appointment. Supplies are limited for one or more test you selected. Thank you.

For lipid panels - to ensure accurate results for triglycerides and glucose in the panel you must fast for at least 9 hours before the test.

Patient Details

Patient Contact Information

Health Screening

Health Insurance Information

MCP Staff Use Only - Please go back up to submit

Minerva Medicine Center Pharmacy Testing Appointments

COVID-19 and Flu testing will be done curbside. Please do not enter the pharmacy for these tests. Follow the signs in the parking lot.

**SAME DAY APPOINTMENT** - Please check with the store to see if they are able to accommodate your appointment. Supplies are limited for one or more test you selected. Thank you.

For lipid panels - to ensure accurate results for triglycerides and glucose in the panel you must fast for at least 9 hours before the test.

Patient Details

Patient Contact Information

Health Screening

Health Insurance Information

MCP Staff Use Only - Please go back up to submit

SAME DAY APPOINTMENT - Please check with the store to see if they are able to accommodate your appointment. Supplies are limited for one or more test you selected. Thank you.