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COVID-19 and Influenza (Flu) Medical History Form: Adults 65 Years and Older Please complete this form with information about your COVID-19 and influenza (flu) medical history. This form is for your

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How to fill out covid-19 and influenza flu

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Wash your hands thoroughly with soap and water before handling the form.

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Fill in your personal information including name, date of birth, and contact information.

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Answer all questions regarding symptoms or exposure to COVID-19 and influenza flu accurately.

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Who needs covid-19 and influenza flu?

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Individuals who suspect they may have been exposed to or are experiencing symptoms of COVID-19 or influenza flu.

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Healthcare workers who are in contact with patients who may have COVID-19 or influenza flu.

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Individuals who are required to undergo testing for COVID-19 or influenza flu as per public health guidelines.

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What is covid-19 and influenza flu?

COVID-19 is a respiratory illness caused by the coronavirus SARS-CoV-2, while influenza flu is caused by different strains of the influenza virus.

Who is required to file covid-19 and influenza flu?

Healthcare providers and institutions are typically required to report cases of COVID-19 and influenza flu.

How to fill out covid-19 and influenza flu?

Providers must report cases through their local health department or other designated reporting systems.

What is the purpose of covid-19 and influenza flu?

The purpose of reporting COVID-19 and influenza flu is to track cases, monitor trends, and help prevent the spread of these diseases.

What information must be reported on covid-19 and influenza flu?

Information such as patient demographics, symptoms, test results, and potential sources of exposure must be reported.

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