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PRINTED: 06/01/2020 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION
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Step 1: Obtain the residential covid-19 focused infection form from the designated authority.
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Step 2: Fill out your personal details such as name, address, contact information, and date of birth.
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Step 3: Provide information about any symptoms you may be experiencing related to covid-19.
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Step 4: Mention your recent travel history, if any, including destinations and dates.
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Step 5: Answer questions about your exposure to individuals who have tested positive for covid-19.
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Step 6: Include any additional relevant information or medical history related to covid-19.
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Step 7: Review the form to ensure all information is accurate and complete.
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Step 8: Submit the filled-out form to the designated authority through the prescribed channels.

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Anyone who suspects they have been infected with covid-19 and requires residential care or assistance should fill out the residential covid-19 focused infection form.
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Residential covid-19 focused infection refers to tracking and reporting cases of covid-19 specifically in residential settings such as nursing homes or group homes.
Healthcare facilities and residential care providers are required to file residential covid-19 focused infection reports.
The residential covid-19 focused infection report can be filled out online through a specified reporting portal provided by the health department.
The purpose of residential covid-19 focused infection reports is to track and monitor the spread of covid-19 in residential settings, identify outbreaks, and implement proper control measures.
Information that must be reported includes the number of cases, deaths, staff infections, mitigation measures in place, and testing protocols.
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