Get the free COVID-19 Extended Form - Washington State Department of Health

COVID-19 Screening QuestionnaireFirst Name: Last Name: Street: City: State: Zip: Phone: Email: Please check all that apply:you had a close contact with confirmed or suspected COVID-19 cases within

How to fill out covid-19 extended form

How to fill out covid-19 extended form

1. Step 1: Start by opening the covid-19 extended form.
2. Step 2: Fill in your personal information such as name, age, and contact details.
3. Step 3: Provide details about your recent travel history, including the countries you have visited and the dates of travel.
4. Step 4: Answer the questions about your current health condition, such as any symptoms you may be experiencing.
5. Step 5: If applicable, provide information about any contact you may have had with confirmed covid-19 cases.
6. Step 6: Review the form for any errors or omissions.
7. Step 7: Sign and date the form to confirm the accuracy of the information provided.
8. Step 8: Submit the form to the appropriate authorities or healthcare provider, as instructed.

Who needs covid-19 extended form?

1. The covid-19 extended form is needed by individuals who have been asked to provide detailed information about their health condition, travel history, and contact with confirmed cases of covid-19. This may include individuals who are traveling, seeking medical treatment, or undergoing screening or quarantine measures.

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What is covid-19 extended form?

The covid-19 extended form is a document used to report additional information related to covid-19 cases or impacts.

Who is required to file covid-19 extended form?

Healthcare facilities, employers, and individuals may be required to file the covid-19 extended form depending on the specific circumstance.

How to fill out covid-19 extended form?

The covid-19 extended form can typically be filled out online or submitted manually by providing the required information about covid-19 cases or impacts.

What is the purpose of covid-19 extended form?

The purpose of the covid-19 extended form is to gather detailed information about covid-19 cases or impacts for analysis and tracking purposes.

What information must be reported on covid-19 extended form?

Information such as demographics of individuals affected, location of cases, symptoms, date of diagnosis, and any related exposures may be required to be reported on the covid-19 extended form.