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COVID-19 Outbreak Report Form for Long Term Care Facilities* Long Term Care Facility Outbreak Definitions Respiratory illness: Fever (100 o F) OR lower respiratory illness (new cough or shortness

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How to fill out covid-19intake-form-hldpub

01

To fill out the covid-19intake-form-hldpub, follow these steps:

02

Start by entering your personal information, such as your name, date of birth, and contact details.

03

Answer the questionnaire honestly, providing accurate information about your health and any symptoms you may be experiencing.

04

Provide information about your recent travel history, including any international trips or visits to high-risk areas.

05

Specify any pre-existing medical conditions or underlying health issues that you may have.

06

If you have been in close contact with someone who has tested positive for COVID-19, make sure to mention it.

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Complete the form by reviewing your answers and ensuring everything is filled out correctly.

08

Submit the form electronically or as directed by the healthcare facility or organization that requires it.

Who needs covid-19intake-form-hldpub?

01

Anyone who needs to report their health status and provide relevant information regarding COVID-19 may need to fill out the covid-19intake-form-hldpub. This form is commonly used by healthcare facilities, clinics, testing centers, and government agencies to gather essential data for screening, contact tracing, and monitoring purposes. Individuals who suspect they may have been exposed to COVID-19 or are experiencing symptoms should also consider filling out this form to aid in the assessment and management of their case.

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