MDA REQUIRED DATA COLLECTION

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MDA REQUIRED DATA COLLECTION

This form is for COVICHEK COVID19 AG SALIVA SELF - TEST KIT submission only.

NAME : COVICHEK COVID-19 AG SALIVA SELF - TEST

BRAND : WIZCHEM

CONDITIONAL APPROVAL LETTER REFERENCE NUMBER :

BATCH NUMBER :

LOT NUMBER :

SERIAL NUMBER :

YOUR NAME ( As per NRIC / Passport )(Required)

First Last

PHONE NUMBER(Required)

EMAIL ADDRESS(Required)

ADDRESS(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

DATE OF PURCHASE(Required)

TIME OF PURCHASE(Required)

NAME OF PREMISE THE PURCHASE MADE(Required)

Prefix

UPLOAD YOUR RECEIPT(Required)

Max. file size: 200 MB.

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Instruction for Use

COVICHEK COVID-19 Ag

DISCARD PROCEDURE AFTER USE

1. After test is completed, place the test unit in plastic biohazard bag and
dispose all test kit materials with biohazard waste disposal protocol

***All specimens and the used-kit has the infectious risk. Discard all the test
components in the provided biohazard specimen bag after use***

REPORTING COVID19 RESULT METHOD

1) If the test result is positive

Result shall be reported to KKM on MySejahtera app.

Open the App> Press Helpdesk> Start> Select F “I am Covid-19 Positive
and would like to report my results”> then please update all the
information required

or Scan the QR Code attached below.

2) If the test result is Negative
If you have the symptoms, please go to a private health facility or health
clinic for a health assessment.

3) If the test result is invalid or an error is displayed
If the self-diagnosis display shows incorrect results or test errors, we would
recommend retesting within 2- 3 days.