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Auxiliary COVID-19 High-rise Assessment Form PRIVACY ACT STATEMENTAuthority: 5 U.S.C. 301; 44 U.S.C. 3101; 14 U.S.C. 39023904; 14 U.S.C. 39123913; 14 U.S.C. 93, Commandant; general powers Purpose:

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How to fill out auxiliary covid-19 high-risk assessment

01

Step 1: Obtain the auxiliary covid-19 high-risk assessment form

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Step 2: Fill out personal information including name, date of birth, and contact information

03

Step 3: Answer questions related to health conditions such as chronic illnesses, immunocompromised status, and recent symptoms

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Step 4: Provide details on recent travel history and exposure to individuals with confirmed cases of covid-19

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Step 5: Submit the completed form to the designated healthcare provider or organization

Who needs auxiliary covid-19 high-risk assessment?

01

Individuals who have underlying health conditions that may put them at higher risk of severe illness from covid-19

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Those who have been in close contact with a confirmed case of covid-19

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People with a history of recent travel to high-risk areas

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What is auxiliary covid-19 high-risk assessment?

Auxiliary covid-19 high-risk assessment is a form used to evaluate the risk level of individuals who may be more vulnerable to severe outcomes if they contract the Covid-19 virus.

Who is required to file auxiliary covid-19 high-risk assessment?

Healthcare providers and facilities are required to file auxiliary covid-19 high-risk assessment for their patients who fall into the high-risk category.

How to fill out auxiliary covid-19 high-risk assessment?

Auxiliary covid-19 high-risk assessment can be filled out by providing relevant medical history, medications, and any existing health conditions that may increase the risk of severe illness from Covid-19.

What is the purpose of auxiliary covid-19 high-risk assessment?

The purpose of auxiliary covid-19 high-risk assessment is to help healthcare providers identify individuals who may need additional care or monitoring due to their increased risk of severe illness from Covid-19.

What information must be reported on auxiliary covid-19 high-risk assessment?

Information such as medical history, current medications, existing health conditions, and any other relevant factors that may contribute to the individual's risk level for severe illness from Covid-19 must be reported on auxiliary covid-19 high-risk assessment.

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