Choose or Enter Laboratory Name where test has been done*
Alfa Diagnostic Lab, Lalitpur Alka Lab Alpha Health Care and Diagnostic Centre, New Baneshwor B & B Hospital, Lalitpur B-Sure Diagnostic Center, Biratnagar B.P. Koirala Memorial Cancer Hospital Laboratory Bageswari Diagnostic and Polyclinic Center (P.) Ltd., Nepalgunj Baitadi Hospital Laboratory Bajhang Hospital Laboratory Bhaktapur Hospital, Bhaktapur Bharatpur COVID-19 Diagnostic Lab, Chitwan Bheri Hospital, Nepalgunj, Banke BIDH Lab, Lalitpur Bir Hospital, Kathmandu Birat medical College and Teaching Hospital, Biratnagar Birendra Army Hospital, Chhauni BP Koirala Institute of Health Science, Dharan Central Diagnostic Laboratory & Research Center Pvt. Ltd. Chaurjahari Municipality PCR Laboratory, Rukum E Chitwan Medical College, Bharatpur Civil Service Hospital COVID-19 Testing Laboratory, Dailekh COVID19 Diagnostic Laboratory-The Leprosy Crystal Diagnostic Pvt. Ltd. Dadeldhura Hospital Laboratory, Dadeldhura Decode Genomics & Research Center, Kathmandu Dhankuta Hospital Dhulikhel Hospital, Dhulikhel Doti Hospital, Doti Dr. Iwamura Memorial Hospital Laboratory Gajendra Narayan Singh Hospital, Rajbiraj, Saptari Global Hospital & Education Foundation Pvt. LTD Green City Hospital Gulmi COVID-19 Laboratory HAMS Hospital, Kathmandu Hetauda Hospital, Hetauda Intrepid Diagnostic Center Pvt. Ltd., Kathmandu Investigation Laboratory, Dhangadi Janamaitri Hospital Kantipur Dental College Teaching Hospital and Research Center, Basundhara Kantipur Lab Karnali Academy of Health Science, Jumla KGDH Teaching Hospital and Research Center KMC Hospital, Kathmandu Koshi Hospital, Biratnagar Kritipur Municipality-TU Biotech Corona Lab Life Care Lab, Pokhara Lumbini Medical College Lumbini Provincial Hospital Mahakali Hospital Mahendra Narayan Nidhi Memorial Hospital, Basundhara Manmohan Memorial Medical College and Teaching Hospital, Swayambhu Mechi Hospital, Jhapa Mission Nepal Anandaban Hospital, Lele, Lalitpur Modern Digonostic Centre Nepal Pvt.Ltd., Basundhara Narayani Hospital, Birgunj National Medical College National Path Lab & Research Center Pvt. Ltd. National Public Health laboratory (NPHL), Kathmandu Nepal Armed Police Force Hospital (APF), Balambu, Kathmandu Nepal Korea Friendship Hospital, Bhaktapur Nepal Mediciti Hospital, Lalitpur Nepal Police Hospital Laboratory, Kathmandu Nepalgunj Medical College, Kohalpur, Banke Neurocardio and Multispeciality Hospital, Biratnagar NMC Molecular and Clinical Genetic Lab, Jorpati Nobel Medical college and Teaching Hospital, Biratnagar Paropakar Maternity and Women's Hospital Patan Hospital, lalitpur Pokhara Academy of Health Science, Pokhara Province Hospital Surkhet Provincial Public Health Laboratory, Biratnagar Provincial Public Health Laboratory, Dhulikhel Provincial Public Health Laboratory, Janakpur Provincial Public Health Laboratory, Rupandehi Provincial Tuberculosis Control Center /Provincial Public Health Laboratory, Pokhara Rapti Academy of Health Science, Dang Seti Provincial Hospital/ Avian Disease Siddhi Poly Path Lab Sooriya Health Care Pvt. Ltd Star Hospital Limited, Lalitpur Sukra Raj Tropical and Infectious Disease Hospital, Kathmandu Sumeru Hospital, Lalitpur Surkhet Provincial Hospital/Avian Disease Investigation Laboratory, Surkhet Tirshuli Hospital Tribhuvan University and Teaching Hospital, Kathmandu Universal College of Medical Sciences
6.6.2 Please specify any Chronic condition you have
Hypertension(HTN) Cardiovascular and Cerebrovascular diseases Endocrine system(Diabetes) Co-existing infection(HIV and Hepatitis B) Cancer Respiratory system(COPD and others) Renal disorder Immunodeficiency states Liver Disease Chronic Lung Disease Neurological Disorder Old age (>65 yrs) Other
For Ladies only
6.7.2 If Pregnant, kindly specify the month
The above information is correct and I am subject to legal consequences if found otherwise.
I will abide by the health directives issued by the Government of Travelling Country during my stay in Quarantine.
I will take utmost care to abide by the health directives of the Government of Travelling Country to contain the possible spread of COVID 19 from me to the community.
The above information is correct and I am subject to legal consequences if found otherwise.*