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Patient Name MI Last Name Date of Birth Email Parent name if minor: Address City State Zip Code Home/Cell Phone Referred by: Online Friend/Family Social Media Weber Other: Medical & Dental History
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Start by obtaining the Michigan Interim COVID-19 Person Form. This form can be found on the official website of the Michigan Department of Health and Human Services.
02
Fill in your personal information accurately. This includes your full name, date of birth, address, phone number, and email.
03
Provide details about your current health status. Answer the questions regarding symptoms, exposure to COVID-19, and recent travel history.
04
Include details about any medical conditions or underlying health issues you may have. This information helps health authorities assess your risk level.
05
Sign and date the form to certify the accuracy of the information provided.
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Submit the completed form as instructed by the Michigan Department of Health and Human Services. This may involve mailing it or submitting it online.
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Keep a copy of the filled-out form for your records and reference.

Who needs michigan interim covid-19 person?

01
Anyone living in or visiting Michigan who wants to report their COVID-19 status or potential exposure should fill out the Michigan Interim COVID-19 Person Form. This includes residents, workers, students, travelers, and anyone who believes they may have been in contact with the virus or is experiencing symptoms.
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Michigan interim COVID-19 person refers to an individual designated by a business to oversee and ensure compliance with COVID-19 workplace safety measures.
All businesses in Michigan are required to designate and file a Michigan interim COVID-19 person.
To fill out Michigan interim COVID-19 person, businesses need to designate an individual responsible for overseeing and implementing COVID-19 safety measures at the workplace.
The purpose of Michigan interim COVID-19 person is to ensure compliance with COVID-19 workplace safety regulations and to protect the health of employees.
Information such as the designated individual's name, contact details, responsibilities, and training on COVID-19 safety measures must be reported on Michigan interim COVID-19 person.
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