National Flat File for COVID-19

The National Flat File (NFF) is an electronic reporting method for laboratories to submit COVID-19 results to public health. NFF meets laboratory notifiable condition reporting requirements in Washington State and includes entry-fields for the HHS COVID-19 reporting requirements.

Washington State law requires  laboratories to report (i.e. fax) all COVID-19 results to the local health jurisdiction of the patient's residence; this includes positive, negative, inconclusive, and other results.

Jurisdiction contact information can be found on this webpage:

NFF reporting meets requirements for laboratories as defined under the Washington Administration Code (WAC) Chapter 246-101 and should only be used for COVID-19 results reporting.

Reporting COVID-19 test results

To address COVID-19 news on federal and state requirements, DOH created an FAQ page specific to reporting COVID-19 test results.


How was NFF established?

The Association of Public Health Laboratories (APHL) developed the National ELR Flat File and HL7 Generator Tool - dubbed NFF.

How is NFF used?

The HL7 Generator is a tool based in Microsoft Excel used to generate an HL7 V2.5.1 ELR R1 specification-based data output file for COVID-19 test results. It is compliant with all data format and value constraints imposed by the CDC and HHS.

May I use ELR instead of NFF for COVID-19 reporting?

If your organization can generate HL7 messages without the aid of NFF, then yes.

If you are already using ELR for other notifiable conditions, email and let us know before adding COVID-19 to your production feed.

Helpful Guidance for using NFF

Manual Reporting or Faxing: Until the entire NFF onboarding process is complete, it is imperative to continue manual reporting (faxing) all COVID-19 results to the local health jurisdiction where the patient resides.

If your organization is not a laboratory, and you are reporting point of care (POC) tests, see your reporting options at: Reporting COVID-19 Test Results for Point-of-Care Testing Facilities :: Washington State Department of Health.

All other test results must be manually reported or faxed.

Upon successful completion of the NFF onboarding process, laboratories no longer need to fax COVID-19 results. The ELR team will send a confirmation when faxing can stop.

Join our Listserv

Listserv: The ELR team has created a listserv to provide general information about Washington specific electronic laboratory reporting, national updates, frequently asked questions, and future listening sessions. Emails will be sent out as needed and average about one to two emails per month. Subscribe to the listserv.


NFF Onboarding Process

1. Complete the registration form

To begin, complete the registration form. The ELR onboarding team will reply to your form by email.

2. Select an NFF format

Choose the NFF format that works best for your laboratory. You can either:

  • Manually enter data into the NFF spreadsheet
  • Use a report writer to develop an automated data file


Both formats have been carefully developed to load into our surveillance system, and we do not accept other formats.


3. Create your test file

In the downloaded toolkit, APHL has included instructions and advice for creating and validating your files. They have already provided walkthrough videos for using the national flat file.


Once you have a test file ready, follow APHL's directions to run the file through the NIST validation tool. We recommend downloading the tool to protect confidential information in your test file. When you have a clean NIST report, email the NIST report PDF as an attachment to the ELR team.

Please do not email your test file with personally identifiable information.


4. Set-up transport

You must communicate to the ELR team which transport method will be used, and works best for your agency. Your options are:

  • APHL Informatics Messaging Services (AIMS) via APHL. Laboratories who use AIMS may submit all their testing data, and AIMS will route results to the appropriate states. Please work with APHL directly if you are interested in this option.
  • OneHealthPort Health Information Exchange (HIE) is DOH's preferred ELR transport method. If you already have an account or are considering reporting notifiable conditions beyond COVID-19, this is your best option.
  • Secure File Transfer (SFT) may be an option for COVID-19 only reporting, and the ELR staff will discuss requirements to using SFT accounts with DOH. If approved for an SFT account, instructions will be sent when you have a test file for review.


These are the only methods you can use to submit NFF data. Do not email personally identifiable information.

5. Validation Queue

Once we receive your NIST report, you will be placed into the validation queue. The length of the queue has grown as more entities have signed up due to COVID-19 reporting; wait times have increased over time. Once a submitter reaches the front of the queue, agency staff will reach out and arrange a kickoff meeting to review requirements for submitting data and moving on to validation.

6. Structural validation

Once your laboratory has developed a file using one of the NFF formats, and when you are instructed by DOH staff, submit a sample file through the transport method you selected.

While we are moving your test file into our WA Disease Reporting System onboarding platform, you may receive emails on structural errors that need to be resolved.

7. Content validation

When the data is in WDRS onboarding, we will perform content validation to ensure data fields are entered correctly. The onboarding team will work with you on any further edits. During the validation process, the onboarding team may ask you to submit additional data files to ensure your file can be successfully processed before moving into production.

All issues identified during the validation process must be addressed before an entity can move to production reporting. If you have any questions or would like further information about validation, please contact us.

8. Submit COVID-19 results via NFF

The ELR onboarding team will give you the green light to move into parallel production for two weeks. During this time, we request that you continue to manually report results while submitting data electronically. Once we confirm all results received with no issues, we will work with you to identify a cut-off time to begin submitting COVID-19 results by NFF only, so you may stop manually reporting results. We will also walk you through the process of submitting backlog results, if any.

Contact Information


For questions about NFF or ELR, please contact