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PRINTED: 05/20/2020 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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How to fill out a covid -19 infection

01

Wash your hands thoroughly with soap and water for at least 20 seconds before beginning.

02

Use a clean tissue to cough or sneeze into, and dispose of it immediately.

03

Wear a mask to cover your nose and mouth.

04

Maintain social distancing of at least 6 feet from others.

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Avoid touching your face, especially your eyes, nose, and mouth.

Who needs a covid -19 infection?

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Anyone who is experiencing symptoms of COVID-19 such as fever, cough, shortness of breath, or loss of taste or smell.

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Individuals who have been in close contact with someone diagnosed with COVID-19.

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Healthcare workers, essential workers, and those working in high-risk environments.

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What is a covid -19 infection?

A covid-19 infection is caused by the SARS-CoV-2 virus.

Who is required to file a covid -19 infection?

Individuals who have tested positive for covid-19 are required to report their infection.

How to fill out a covid -19 infection?

A covid-19 infection can be reported online or through a healthcare provider.

What is the purpose of a covid -19 infection?

The purpose of reporting a covid-19 infection is to help track and control the spread of the virus.

What information must be reported on a covid -19 infection?

Information such as name, contact details, date of positive test, and symptoms must be reported on a covid-19 infection.

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