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Sussex County Government
COVID-19 Intake Recontact Name:
Address:
Contact Phone Number:
Email Address:
For (Person or Department):
Date:
Time:
What is being dropped off? Comments:Revised 03/18/2020
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How to fill out covid-19 intake form
01
Start by opening the COVID-19 intake form on your device.
02
Read the instructions and questions carefully.
03
Fill out your personal information like name, date of birth, and contact details.
04
Answer the screening questions honestly by selecting the appropriate options.
05
Provide information about your symptoms if you are experiencing any.
06
If you have traveled recently, mention the countries you visited.
07
Confirm whether you have been in close contact with a confirmed COVID-19 patient.
08
Submit the form once you have completed all the sections.
09
Follow any additional instructions given by the form or healthcare provider.
Who needs covid-19 intake form?
01
Anyone who is experiencing COVID-19 symptoms or has been in contact with a confirmed COVID-19 case may need to fill out a COVID-19 intake form.
02
Healthcare providers may require patients to complete the form for better understanding and assessment of their condition.
03
Certain workplaces or institutions may also ask individuals to fill out the form as part of their screening process.
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What is covid-19 intake form?
The COVID-19 intake form is a document designed to collect essential information regarding an individual's health status, exposure to the virus, and previous infection history to assess risk and guide care.
Who is required to file covid-19 intake form?
Individuals who exhibit symptoms of COVID-19, have been exposed to someone with the virus, or are seeking medical assessment related to COVID-19 are typically required to fill out the intake form.
How to fill out covid-19 intake form?
To fill out the COVID-19 intake form, individuals should provide personal information, describe symptoms, disclose any recent travel history, and inform about any known exposures to COVID-19.
What is the purpose of covid-19 intake form?
The purpose of the COVID-19 intake form is to gather critical health information to identify potential cases of the virus, inform medical evaluation, and enhance decision-making regarding testing and treatment.
What information must be reported on covid-19 intake form?
The information that must be reported includes personal identification details, symptoms experienced, any recent contact with confirmed COVID-19 cases, and travel history.
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