COVID-19 Testing Program Registration

To reduce transmission of COVID-19, the New Mexico Department of Health (NM DOH) is distributing federal funds for COVID-19 testing programs to New Mexico school districts, public charter schools, Bureau of Indian Education (BIE)/tribally-controlled schools, and non public schools.

This program offers our schools choices in their COVID-19 testing and screening approach, supports Test to Stay, and allows modification throughout the school year. Participation in this optional, fully-funded program is highly encouraged to keep students safe and minimize classroom disruption.

Read Before Beginning This Registration

This form must be completed by the individual authorized to sign and accept funding and assurances (i.e., Superintendent, Charter School Leader, Executive Director). Only one form will be accepted for each school district, public charter schools, Bureau of Indian Education (BIE)/tribally-controlled schools, and non public schools.
Please identify the main point of contact for your school district or school’s COVID-19 Testing and Screening Program.
Read the guidance documents on www.NMSchoolsCovidTesting.com to learn about the options available to you and make your selection before completing this registration.
If you are planning on performing Point of Care (PoC) testing at your school site(s), you are required to submit a CLIA Certificate of Waiver. If you already have a Waiver on file, please be prepared to upload an electronic copy with this registration.

Questions? info@nmschoolscovidtesting.com.

Registration Form

1 - Registration Information

I am submitting for a...(Required)

Public School District

Public Charter

Non Public School

Bureau of Indian Education (BIE)/ Tribally-Controlled School

Public School District(Required)

If your school or district is not listed above, please contact us at info@nmschoolscovidtesting.com.

Public Charter(Required)

If your school or district is not listed above, please contact us at info@nmschoolscovidtesting.com.

Non Public School(Required)

If your school or district is not listed above, please contact us at info@nmschoolscovidtesting.com.

Bureau of Indian Education (BIE)/ Tribally-Controlled School(Required)

If your school or district is not listed above, please contact us at info@nmschoolscovidtesting.com.

Does each school site have an active CLIA Certificate of Waiver?(Required)

Yes

Currently applying

Not Sure

Please upload your CLIA Certificate of Waiver here(Required)

Accepted file types: pdf, doc, , Max. file size: 50 MB.

If you have multiple active CLIA Certificate of Waivers, please upload a single document with all of them attached. For questions about the CLIA Certificate of Waivers, watch our webinar or contact the Division of Health Improvement.

Districts should not include charter school enrollment in their submission.

Total Student Enrollment(Required)

Total Number of Staff(Required)

How many students do you expect to test on a weekly basis?(Required)

How many staff do you expect to test on a weekly basis?(Required)

2 - Authorized Signer (Superintendent, Charter School Leader, Executive Director) Contact Information:

Name(Required)

First Last

Email(Required)

Phone(Required)

Title(Required)

Is Authorized Signer also the COVID-19 Point of Contact or School Testing Coordinator?(Required)

Yes

COVID-19 Point of Contact/School Testing Coordinator Contact Information

Name(Required)

First Last

Email(Required)

Phone(Required)

Title(Required)

Should anyone in addition to the COVID-19 Point of Contact or School Testing Coordinator be copied (CC’d) in emails regarding this program?(Required)

Yes

Please identify the contact information for your COVID-19 Point of Contact or School Testing Coordinator. All communication regarding this program will be sent via email to this individual:

Name(Required)

First Last

Email(Required)

Phone(Required)

Title(Required)

3 - Screening and Testing Program Selection

Hidden

I have read the COVID-19 Testing and Screening Options document, which outlines the testing types and methodologies available to my school or district.(Required)

Yes

Will your school district or school participate in Full-Service COVID-19 Testing Program with PMG (Program Option A)?(Required)

Yes

Click here to learn more about Program Option A

Which type of testing program would you like to implement with support from PMG? Select all that apply.(Required)

Surveillance Testing

Exposed/Symptomatic only

Staff Testing

Test to Stay

What type of testing? Select as many as apply.(Required)

Pooled PCR Testing

Rapid PCR Testing

Individualized PCR Testing

Rapid Antigen Testing

Will your school district or school like to use your own staff, trained by PMG, to implement or support testing on-site (Program Option B)?(Required)

Yes

Click here to learn more about Program Option B

What type of testing would you like training on? Select as many as apply.(Required)

Rapid Antigen Test

Rapid PCR Test

Lab Based PCR Test

Lab Based Pooled PCR Test

Does your school or school district plan to order rapid antigen test kits through this program for diagnostic testing, screening, and/or staff surveillance (Program Option C)?(Required)

Yes

Click here to learn more about Program Option C

Financial support is available for staffing (expansion or supplementation), waste management fees and associated equipment, CLIA Certificate of Waiver fees, equipment for appropriate storage of kits, and other related costs. Are you interested in applying for these funds (Program Option D)?
As of March 4, 2022, registration has closed for Program Option D.

Hidden

Yes

To be eligible for funds, you must either participate in the Full-Service Testing Program, conduct COVID-19 testing with your own staff, or contract with another testing provider.
Click here to learn more about Program Option D

Full-Service Provider COVID-19 Testing and Screening Conditions

Screening Conditions(Required)

To reduce transmission of COVID-19 and to support in-person instruction, the New Mexico Department of Health (NM DOH) is making COVID-19 school-based pooled testing services available to districts and schools at no cost through the end of the 2021-2022 school year. This will include extended and summer school. Schools and districts must submit an application at the link provided by NM DOH to receive testing and related services.

Pooled testing services for COVID-19 combine, i.e., “pool,” a set of individual test specimens and yield a single test result for the overall pool. The pooled test results are not intended for diagnostic or treatment purposes but instead serve as a screening tool to increase the likelihood of identifying possible positive cases in the school population.

Consent and Privacy

Applicant will follow all pooled testing program guidance and requirements provided by the NM DOH or the pooled testing service. Prior to pooled test administration, Applicant will collect and maintain all required consent for the administration of a pooled test from students’ parents/guardians, teachers, staff, and any other person participating in the pooled testing program. Applicant must use the consent form furnished by the pooled testing provider.

Applicant will protect the privacy of individuals participating in the pooled testing program. If needed for follow-up testing, personally identifiable information (PII) about students from education records may be disclosed to the pooled testing provider, only after parents have consented to testing and sharing results or as otherwise permitted by the federal Family Educational Rights Privacy Act. Applicant will refrain from charging students, teachers, staff, or other members of the school community for any costs associated with participating in the pooled testing program.

Testing Protocols

Staff and students with consent may participate in the pooled screening and surveillance COVID-19 once per week regardless of vaccination status, on a schedule set by the authorized school and the testing provider. It is recommended that 25 percent of student population be screened every week with the pooled method of COVID-19 screening. Applicant must follow all requirements for surveillance testing per the NM Public Health Order or NM PED toolkit. Results from the pooled screening can be used to meet requirements for NM educational staff surveillance.

Applicant will have plans and written protocols in place for contact tracing, home quarantine, and reporting for all positive test result from the pooled testing screening an at a minimum follow the NM PED Toolkit. For staff or students requesting diagnostic COVID -19 testing due to COVID-19 like symptoms or COVID -19 exposure, the pooled testing screening may be used; however, other options perhaps would be better suited for this situation.

Isolation, Quarantine, and Contact Tracing

To determine the exact source(s) of the positive test result, Applicant must also have in place appropriate protocols to ensure individuals stay home from school until it is safe to return, follow NM DOH isolation and quarantine protocols, and conduct additional contact tracing if necessary, and to report to NM DOH positive individual diagnostic test results within 24 hours.

Training & Compliance

Applicant will communicate with teachers, staff, students, and families about this program on an ongoing basis and coordinate training to be provided by the pooled testing provider for staff that will be conducting these tests. Applicant will work with the pooled testing provider, depending on the support level needed, to promote an effective delivery of this program including following instructions from the pooled testing provider or the NM DOH.

Platform Terms & Conditions

Applicant acknowledges the requirement, for itself and its authorized users, to comply with the following Terms & Conditions of engagement with the assigned pooled testing provider:

Access; Restrictions. Applicant will access and use the pooled testing provider’s online portal and any related software (collectively, the “Platform”) solely for the school’s internal, non-commercial purposes. Applicant will not, and will not permit any third party to, directly or indirectly (a) reverse engineer the Platform or attempt to discover or disclose any underlying ideas, algorithms or source code (except to the extent such restriction is prohibited by law); (b) publish, modify, reproduce or create derivative works based on the Platform or any data contained therein; (c) sell, offer for sale, rent, lease, license, sublicense, or redistribute any or all of the Platform or any data contained therein; (d) circumvent, remove, deactivate or thwart any protections or security measures in the Platform; or (e) otherwise access or use the Platform or any data or information received through the software in a manner inconsistent with this Statement of Assurances (including these Terms & Conditions) or applicable laws, rules and regulations.
Confidentiality. Applicant will hold the Platform and any data or information, including personally identifiable information, received through the Platform in strict confidence and will protect the same with at least the same degree of care with which School protects its own similar confidential information, which protections shall follow applicable laws, rules and regulations, including, without limitation, those related to privacy and personal information.
Representation/Warranty. Applicant represents, warrants, and covenants that it has and will have the legal authority and all rights and consents necessary to provide the data and information it provides under these Terms & Conditions for the purposes described therein, including, without limitation, any consents as required under this Statement of Assurances.
Third Party Beneficiary. The assigned pooled Testing provider is an intended third-party beneficiary of this Statement of Assurances (including these Terms & Conditions) and is entitled to rely upon the rights and benefits hereunder and may directly enforce the provisions hereof as if it were a party hereto. Any oversight, monitoring, or evaluation of the activities of the School by the assigned pooled testing provider or the NMDOH shall not diminish or relieve in any way the liability of the School for any of its duties and responsibilities under this Agreement.

I agree to the above

Abbott BinaxNOW COVID-19 Ag Testing Kit Program Conditions

Screening Conditions

Point of care test are diagnostic tests performed at the place where a specimen is collected, and they provide results within minutes rather than hours. If a school conducts a point of care test, a CLIA Certificate of Waiver is required for every site the CLIA waived test is being conducted. Rapid point-of-care tests provide results within minutes (depending on the test) and are used to detect SARS-CoV-2 infections. For more information about point of care test: Guidance for SARS-CoV-2 Point-of-Care and Rapid Testing | CDC.

The Abbott BinaxNOW COVID-19 Ag test is a point of care rapid antigen test. Antigen tests are commonly used in the diagnosis of respiratory viruses. The U.S. Food and Drug
Administration (FDA) has granted emergency use authorization (EUA) for antigen tests that can identify SARS-CoV-2.

Antigen tests are relatively inexpensive, and most tests return results in approximately 15–30 minutes. Antigen tests for SARS-CoV-2 are generally less sensitive than polymerase chain
reaction (PCR) for detecting the presence of viral nucleic acid.

The clinical performance of a rapid antigen test is best if the person is tested when their viral load is generally highest and used best in symptomatic people and within a certain number of days since symptom onset, antigen tests are used frequently on people who are symptomatic. Antigen tests also may be informative in screening and surveillance to assist in a rapid response. Results of rapid antigen yield the schools ability to assist in rapid response and immediate isolation.

No COVID-19 test is perfect and the rapid antigen test may produce false Notwithstanding the results of any rapid antigen test, participating schools and districts are to encourage members of the school population to consult their individual health care providers if they have signs or symptoms of COVID-19 or otherwise believe they have been exposed to COVID-19. In the
event of a negative test result in a student or staff member that is symptomatic, a PCR based test will be required to confirm or rule out the result of the rapid antigen test.

The participating school or district will coordinate training and ordering from the Abbott Corporation or by the NM DOH once application is received.

To support the effective administration of this program as well as the safe and effective administration of the rapid antigen BinaxNOW COVID -19 Ag test program , the NM DOH seek assurances from [Applicant district/school] before authorizing access to the Abbott Corporation’s training and ordering services.

For access to the Abbott BinaxNOW COVID-19 Ag program, [Applicant district/school] (“Applicant”) must agree to the following:

Consent and Privacy

Applicant will follow Abbott’s BinaxNOW COVID-19 Ag testing program guidance and procedure and will use only Abbott’s BinaxNOW COVID-19 Ag consent form. The school will be responsible for the distribution of the consent and collection of the consent form(s) prior to test administration from students’ parents/guardians, teachers, staff, and any other person participating in the Abbott’s BinaxNOW COVID-19 Ag testing program.

Applicant will protect the privacy of individuals participating in the Abbott’s BinaxNOW COVID-19 Ag program, maintain and archive records per New Mexico Statue.

Testing Protocols

Staff and students with consent may use the Abbott’s BinaxNOW COVID-19 Ag to participate in the testing of symptomatic students/staff, student/staff screening and staff surveillance. The
testing may be conducted for screening and surveillance purposes once per week regardless of vaccination status. It is recommended that 25 percent of student population be screened every
week with the pooled method of COVID-19 screening. Applicant must follow all requirements for surveillance testing per the NM Public Health Order or NM PED toolkit. Results from the Abbott’s BinaxNOW COVID-19 Ag screening can be used to meet requirements for NM educational staff surveillance.

Applicant will have plans and written protocols in place for contact tracing, home quarantine, and reporting for all positive test result from the pooled testing screening an at a minimum follow the NM PED Toolkit. For staff or students requesting diagnostic (symptomatic) COVID - 19 testing due to COVID-19 like symptoms or COVID -19 exposure, the Abbott’s BinaxNOW COVID-19 Ag may be used; however, other options perhaps would be better suited for this situation.

Isolation, Quarantine, and Contact Tracing

If a positive test result from the Abbott’s BinaxNOW COVID-19 Ag test, the Applicant must have in a school isolation space, appropriate protocols to ensure individuals stay home from
school until it is safe to return, follow NM DOH isolation and quarantine protocols, and conduct additional contact tracing if necessary, and to report to NM DOH positive individual diagnostic test results within 24 hours using Simple Reports.

Training, Compliance, Product Ordering and Shipping

Applicant will communicate with teachers, staff, students, and families about this program on an ongoing basis and coordinate training to be provided by the Abbott’s BinaxNOW COVID-19 Ag test. Applicant will work with the NM DOH and be assigned to the Abbott Corporation for training or given Abbott links by the NM DOH. To order test, the Applicant will order directly from Abbott Corporation using order forms found on the NM DOH ELC-Reopening of Schools web page. Once the Abbott Corporation receives order form, Abbott will drop ship to the school or school districts address listed on the order form.

Platform Terms & Conditions

Applicant acknowledges the requirement, for itself and its authorized users, to comply with the following Terms & Conditions of engagement for the Abbott’s BinaxNOW COVID-19 Ag test:

Confidentiality Applicant will hold any data or information, including personally identifiable information, in strict confidence and will protect the same with at least the same degree of care with which School protects its own similar confidential information, which protections shall follow applicable laws, rules and regulations, including, without limitation, those related to privacy and personal information
Representation/Warranty.Applicant represents, warrants, and covenants that it has and will have the legal authority and all rights and consents necessary to provide the data and information it provides under these Terms & Conditions for the purposes described therein, including, without limitation, any consents as required under this Statement of Assurances.
Reporting. Schools and school districts are required to report all results within 24 hours to the NM DOH using Simple Reports, and to follow requirements for reporting authorized by the NM PED.

I agree to the above

4 - Submission

I am authorized to submit this application on behalf of the school or district indicated above and agree to the conditions outlined in this application.

Your Name(Required)

First Last

Today's Date(Required)

Signature(Required)

Name

This field is for validation purposes and should be left unchanged.