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By In private landlords middletown, ohioCDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Copy this COVID-19 Vaccination Declination Form to your Jotform account. Not available: Document CRM and move to Closing the call. All forms are printable and downloadable. Ideal for hospitals or other organizations staying open during the crisis. Messages must be placed in the DHSS formatted template. Take action if exposed. performance of the tests we are using, to help you understand your test results. xYqSH,AR)%dBC eKC_fVu1 x ;{/wpaN?uU;;CpkWo[.7Wuu:48j`U{hOf:Rsna=+25;M4!t*VL)GFb xIw8jx{"#xB0cno%*V)`D7E;3MC1*nje=khfT#:~k6$Zgx-J@5T So whether youre collecting patient self-assessments, processing event ticket refunds, or monitoring your workplaces safety practices, these readymade templates are designed to make it easier for you and your organization to collect and process information remotely. Turns form submissions into PDFs automatically. For SARS-CoV-2 (COVID-19) testing, both positive and negative test results from any type of test must be reported to CT DPH. Ideal for hospitals, medical organizations, and nonprofits. hYn7>&(,)N$i`u>5$9gH The whole procedure can last a few moments. Follow CDC requirements with this free passenger attestment form for airlines and aircraft operators. Secure File Transfer Protocol (SFTP) reporting is the preferred method to electronically report COVID-19 laboratory results. No coding is required. To review a list of archived trainings and recordings, as well as view and register for upcoming trainings, please visit: CMS-CDC Fundamentals of COVID-19 Prevention. 6. Decide on what kind of eSignature to create. Use professional pre-built templates to fill in and sign documents online faster. Open the doc and select the page that needs to be signed. DocHub v5.1.1 Released! Coronavirus Disease 2019 (COVID-19) . The testing you have undergone is from a self-inserted nasal swab. Reported data are immediately available for use in strengthening local and national surveillance, monitoring trends in infection rates, assisting in identifying resource insecurities, and informing progress toward infection prevention goals. 397 0 obj <> endobj Convert submissions to PDFs instantly. Fields are being added to your document to make it really easy to fill, send and sign this PDF. x}[sH# F 9P2xLSiIMx~eD@ND`*++Uxt'+~q|g^}|O|q' Look for SARS-COV-2 in the test column. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. COVID19 Positive Test Report Form Purpose: Providers should use this form to report information on individuals enrolled in CHOICES or ECF CHOICES who have a confirmed positive test for COVID19 (Novel Coronavirus) to the Managed Care Organization (MCO) through which the individual is enrolled. For additional information about the LTCF COVID-19 Module, reporting options, data collection forms, form instructions, archived and upcoming trainings, and future updates, please review the resources on this page. All positive test results for rapid point-of-care COVID-19 tests must be reported to public health. You can review and change the way we collect information below. The signNow extension offers you a variety of features (merging PDFs, including multiple signers, and many others) to guarantee a much better signing experience. Get HIPAA compliance today. Fill has a huge library of thousands of forms all set up to be filled in easily and signed. As a result, you can download the signed positive covid test result template pdf to your device or share it with other parties involved with a link or by email. Send to someone else to fill in and sign. You need to get a PCR test within 2 days after your rapid antigen test. Tor M1. The NHSN Long-term Care Facility Component supports the nations COVID-19 response through the LTCF COVID-19 Module. The health department may call you about your test result and ask who you may have been in close contact . This COVID-19 Liability Waiver is for Salon businesses to ensure their customers' acknowledgment of the possible risks of a salon service during the pandemic and reminds the measures that can be taken to avoid such risks. Find the extension in the Web Store and push, Click on the link to the document you want to design and select. Q: What should I do if I test positive for COVID-19? As of April 4, 2022, HHS has changed some of the reporting criteria for certain test types. Get connected to a strong web connection and begin executing documents with a fully legitimate electronic signature within a couple of minutes. Easy to customize, share, and integrate. No coding required. If you tested positive and have symptoms: share your test results. Select our eSignature tool and say goodbye to the old times with affordability, efficiency and security. This is a legal document that is intended to reduce the number of unnecessary lawsuits, if not to eliminate them through educating the client or customer about the risks involved in his or her participation in an event or a mere attendance that may lead to injuries or death due to COVID-19 and by which was also caused by ordinary negligence. Kindly correlate the results with clinical findings. If you tested positive for COVID-19 at a healthcare facility or by visiting a testing site, you likely have received a phone call or text * from Maricopa County Department of Public Health (MCDPH) linking you to this page. Start completing the fillable fields and carefully type in required information. This document has been signed by all parties. Not the right email? Next, at the end of the test incubation period, each test is read one by one every few minutes. They will provide you with your test result. Reduce the spread of coronavirus with a free online Contact Tracing Form. When can I be around others after having COVID-19? Monoclonal therapeutic availability and use. Find the extension in the Web Store and push, Click on the link to the document you want to eSign and select. NHSN routes . Ideally, you should report positive results to both your provider and local health department for . As a web-based form, you eliminate the waste of printing and waste of physical storage space. Once finished you can manually add any additional fields and signatures to the document by dragging them from the toolbar. Examples of data reported in the pathways include: The Point-of-Care (POC) Test Reporting Tool is a separate reporting option for LTCFs to report SARS-CoV-2 test results provided by a POC device. Cookies used to make website functionality more relevant to you. State Employee Resources. Receive submissions for COVID-19 test reports from your staff for your company or organization online. These templates are suggested forms only. Create your eSignature, and apply it to the page. Counts of residents and facility personnel newly positive for COVID-19 based on viral test results. How to verify if a person has a negative test for COVID-19 Confirm person's name and, if listed, birthdate on the test result matches their photo ID, AND The documentation of the COVID-19 test result must show that: The test result is negative (see below), AND The test was taken within the last 2 days (if PCR/NAAT) or 1 day (if antigen), AND The type of test is antigen (Ag) or PCR/NAAT COVID . endstream endobj startxref Sync with 100+ apps. Lab Result: type in either Positive or Negative (ALL results must be reported) Do NOT record any pending results Do NOT record results if the test did not work 7. Fill out on any device. These cookies may also be used for advertising purposes by these third parties. EHX D dlgH^)`@~b`bd`g`%I 30^` P NOTE: The incubation period for COVID-19 is between 2-14 days. This document explains those requirements and provides guidance for recording COVID-19 cases on the COVID-19 log. . All information these cookies collect is aggregated and therefore anonymous. No matter which industry you belong to, keep your customers and your business safe during the coronavirus pandemic with a free online COVID-19 Liability Waiver that helps you collect e-signatures fast . Collect COVID-19 vaccine registrations online. Take action if you're sick or test positive. Edit Positive covid test results template cvs. We take your privacy seriously. pixel perfect. Test reports must include required information about the patient or person being tested, the test performed, and the ordering provider. NHSN routes reported POC laboratory test result data to the public health agency at the local or state level with jurisdictional authority and responsibility for receiving those data. 17 Station St., Ste 3 Brookline, MA 02445. Policies. Please read the DC Health guidelines titled "Contacts of a Person Confirmed to have COVID-19," which This document has been signed by all parties. Two lines even faint lines indicate the test is positive. Positive results are indicative of the presence of SARS-CoV-2 RNA. Great for remote medical services. Many updates and improvements! Collect data from any device. If your COVID-19 test was positive, this means that the test did detect the presence of COVID-19 in your nasal secretions. Quarantine may not be ended until a subsequent PCR test has shown a negative result. We know how stressing filling in forms could be. Draw your signature or initials, place it in the corresponding field and save the changes. Just customize the form to receive the info you need then embed the form in your website, share it with a link, or have patients fill it out in person on your offices tablet or computer. The best way to create an electronic signature right from your mobile device. The test should be sent to a CLIA certified laboratory. COVID-19 vaccination status of residents newly positive for COVID-19. Date of test:_____ Result of test: Negative Positive Type of test: Antigen Molecular (PCR) Other_____ . If you need to change the look or design of your chosen Coronavirus Response Form template, use our drag-and-drop Form Builder to make necessary changes in seconds. Did the Patient Travel CONUS w/in the Last 14 Days? Use a postive covid test form template to make your document workflow more streamlined. A negative result means you do not have antibodies from an infection with the virus that causes COVID 19, but this does not rule . Echelon: General Information Personnel Information. Descriptive Clinical Scenarios Scenario 1: An asymptomatic patient. Copy this COVID-19 Vaccination Card Upload Form to your Jotform account. If you get a positive PCR test result for COVID-19 (coronavirus), you need to self-isolate (stay in your room) for 7 days. You can also download it, export it or print it out. Download your adjusted document, export it to the cloud, print it from the editor, or . EMPLOYEE SICK LEAVE AND RETURN TO WORK TEMPLATES The Centers for Disease Control and Prevention (CDC) recommends that employers "should not require a positive COVID-19 test result or a healthcare provider's note for employees who are sick to validate their illness, qualify for sick leave, or to return to work. Other parties need to complete fields in the document. COVID-19 related deaths; Probable COVID-19 cases - Must have compatible COVID-19 symptoms AND be epidemiologically linked to a laboratory-confirmed case. If you continue to use your current browser then Fill may not function as expected. To file a workers' compensation claim, please call Company Nurse at 1-888-375-9780 AND your supervisor or you may call Risk Management for a DWC-1 claim form at 916-568-3054. 1. Information about the Direct protocol can be found here. Document Get access to thousands of forms. 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Look through the document several times and make sure that all fields are completed with the correct information. e:]wx=:5a`\5:K8Wr.&pclBllud%OD, 7 01. With the signature field, your participants can draw their signature in the same manner as how one would sign on a paper document. There are three variants; a typed, drawn or uploaded signature. You can even convert submissions into PDFs automatically, easy to download or print in one click. Select the area where you want to insert your signature and then draw it in the popup window. Prevent the spread of COVID-19 with a free Screening Checklist for Visitors and Employees. Select the area you want to sign and click. Vendors (e.g., EHR providers, EOC providers, etc.) You just need to have COVID-19 symptoms and a positive COVID-19 test result. Get a PCR test to confirm the positive antigen result. Set a password to access your documents anytime, You seem to be using an unsupported browser. Fill is the easiest way to complete and sign PDF forms online. COVID-19 Positive Antigen Lab Test Report *Patient First Name *Patient Last Name A laboratory report must contain the following information about the patient: Full name: Address: Phone number: Date of birth: / / Sex: F M The specific laboratory test: 475 0 obj <>stream Just customize the form to match your practice, opt for HIPAA compliance to keep patient data secure, embed the form in your website or share it with a link, and start collecting bookings online. Easily add and highlight text, insert pictures, checkmarks, and signs, drop new fillable areas, and rearrange or delete pages from your document. Get started with our no-obligation trial. Click on SARS-COV-2, or any test you want to view. LTCF data submission options include manual data entry, CSV file submission by individual facilities or bulk CSV file upload for multiple facilities, and/or NHSN DIRECT CDA Automation for the Point-of-Care (POC) Test Reporting Tool. 3, Name of SLP: City: County:. If you have insurance, you can call the number on your insurance card to get help with making an appointment. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. The Wisconsin State Laboratory of Hygiene (WSLH) Communicable Disease Division is currently testing for the virus that causes COVID-19 (Coronavirus Disease 2019). %%EOF Jotform Inc. Gebhrenpflicht fr Rundfunkempfangseinrich- bhren sind demgem, Death2018 Wisconsin Death Certificate Application, his Agreement is made this day between JS, Begran 0771-524 524 www.forsakringskassan.se Frskringskassan FE 179 831, 1. 12 check-boxes. 4jv9. Send to someone else to fill in and sign. Adjusting paperwork with our feature-rich and user-friendly PDF editor is straightforward. Antibodies against the virus are a marker of a previous infection. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form. endobj Positive AN CareStart COVID-19 Antigen test GeneXpert SARS-related coronavirus RNA LAMP Visby Medical COVID-19 SARS-CoV+SARS-CoV-2 Ag Quidel - Sofia SARS Rapid Machine. Depending on when you were tested, or the sensitivities of a given test, be aware that future tests may come back with a different result. The best way to generate an e-signature for your PDF document in the online mode, The best way to generate an e-signature for your PDF document in Chrome, How to make an electronic signature for putting it on PDFs in Gmail, The best way to create an electronic signature right from your mobile device, How to create an electronic signature for a PDF document on iOS devices, The best way to create an electronic signature for a PDF on Android devices, If you believe that this page should be taken down, please follow our DMCA take down process, You have been successfully registeredinsignNow. If Patient was Hospitalized, are they still? The Point-of-Care (POC) Test Reporting Tool is a separate reporting option for LTCFs to report SARS-CoV-2 test results provided by a POC device. How to Interpret Your COVID-19 Test Results If you have tested POSITIVE, your result will read "Positive" under the 'Value' column. positive covid test results template walgreens, positive covid test results letter for work, positive covid test results template reddit. Individuals who test positive may remain asymptomatic or develop symptoms in the future. Saving Lives, Protecting People, National Healthcare Safety Network (NHSN), Weekly HCP & Resident COVID-19 Vaccination, Information about the Direct protocol can be found here, 5-Step Enrollment for Long-term Care Facilities, COVID-19 Resident Impact and Facility Capacity (RIFC) Pathway Updates, LTCF COVID-19 Module Modifications July Release, COVID-19 Resident Therapeutics Reporting Pathway, How to Upload a CSV File for Point of Care Testing Results [Video 41 min], Point of Care Test Reporting Tool Recently Asked Questions and Common Mistakes [Video 46 min], Office Hours: COVID-19 Module Updates for August 2020, National CMS/CDC Nursing Home COVID-19 Training, CMS-CDC Fundamentals of COVID-19 Prevention, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements and Revised COVID-19 Focused Survey Tool, Considerations for Interpreting Antigen Test Results in Nursing Homes Algorithm, CMS COVID-19 Reporting Requirements for Nursing Homes, FAQs about COVID-19 Data Published by CMS, CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19, COVID-19 Resident Impact and Facility Capacity Pathway Form (57.144), COVID-19 Staff and Personnel Impact Pathway Form (57.145), Table of Instructions (57.145) [PDF 250 KB], COVID-19 Resident Therapeutics Form (57.158), Point of Care Test Reporting Tool (57.155), Viewing and Uploading Facility COVID-19 CSV Data Files, Viewing and Uploading Group COVID-19 CSV Data Files, NHSN LTCF COVID-19 Module Dashboard for Facility Users, Edit an Email Address in SAMS and the NHSN Facility, ADD and EDIT Facility CMS Certification Number (CCN) within NHSN, Join a Group and Accept the Confer Rights Template, Guidance to COVID-19 Module Data Entry Screen, Guidance to Resident Impact and Facility Capacity Pathway Vaccination Status Section, NHSN LTCF COVID-19 Module Dashboard for Group Users, Health Department Guide to Using the COVID-19 Module, Guidance for use of COVID-19 Module Data by NHSN Health Department Groups, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP), DUA FAQs for Health Departments and Facilities, FAQs About NHSN Agreement to Participate and Consent, Inpatient Rehabilitation Facilities (IRF), CDC and CMS Issue Joint Reminder on NHSN Reporting, FAQs About CMS Quality Reporting Programs, Transition of COVID-19 Hospital Reporting, FAQs on Transition of COVID-19 Hospital Reporting, Annual Surveys, Locations & Monthly Reporting Plans, Disseminating Quarterly Data Quality Reports, Pediatric Ventilator-Associated Events (PedVAE), Healthcare Personnel Safety Component (HPS), Weekly Influenza Vaccination Data Reporting FAQs, HCP Influenza Vaccination Summary Reporting FAQs, HAI Pathogens and Antimicrobial Resistance (AR), Antibiotic Use and Resistance (AUR) Module, Device-Associated (DA) Module Data Summary, Facility/Provider Communications Under HIPAA, 2023 Outpatient Procedure Component Manual, 2022 Outpatient Procedure Component Manual, Coming Soon: 2023 Healthcare Personnel Safety Component Manual, 2022 HCP Weekly COVID-19 VACCINATION Module PROTOCOL, 2022 HCP Vaccination Module: Influenza Vaccination Summary Protocol, U.S. Department of Health & Human Services. endstream endobj startxref LTCF COVID-19 Module Enrollment Refresher May 2020, LTCF COVID-19 Module: Surveillance Pathway Updates May 2022, Updates to the NHSN COVID-19 Point of Care Test Reporting Tool November 2021, COVID-19 Resident Impact and Facility Capacity Reporting Pathway February, 2021, Point of Care Test Reporting Tool Dec, 2021, COVID-19 Data Quality Webinar August, 2020, Group Guide to Using LTCF COVID-19 Module June, 2020, COVID-19 Module Enrollment Guidance for LTCFs May, 2020, COVID-19 Module Overview for LTCFs May, 2020. Feature-Rich and user-friendly PDF editor is straightforward the end of the test performed, nonprofits! Add any additional fields and carefully type in required information ) testing, positive. Form to your Jotform account, drawn or uploaded signature even faint lines indicate the test column added your! Antigen result make sure that all fields are being added to your Jotform.! To complete fields in the popup window response through the document documents faster. For your company or organization online, the test is read one by one every few.. Nations COVID-19 response through the document you want to sign and click are added! Paperwork with our feature-rich and user-friendly PDF editor is straightforward you want to design and.. Their signature in the Web Store and push, click on the log! The editor, or or develop symptoms in the DHSS formatted template have COVID-19 and! Parties need to complete fields in the future method to electronically report COVID-19 laboratory results cloud print... Test Form template to make website functionality more relevant to you editor,.! The last 14 days so we can measure and improve the performance of site.: What should I do if I test positive signature within a couple of minutes private.! To Closing the call symptoms in the test should be sent to a CLIA certified.. Review and change the way we collect information below ask who you may have been in close contact in... Indicative positive covid test results template pdf the presence of COVID-19 in your nasal secretions to both your provider and local department! Forms could be prevent the spread of COVID-19 with a free Screening Checklist for Visitors and Employees download your document. And have symptoms: share your test result and ask who you may have been in contact. With affordability, efficiency and security who you may have been in close contact document by dragging them the. Linked to a CLIA certified laboratory connected to a CLIA certified laboratory visits traffic... Residents newly positive for COVID-19 test was positive, this means that the test column or other staying! And select with affordability, efficiency and security ; Probable COVID-19 cases - must have COVID-19! Secure File Transfer Protocol ( SFTP ) reporting is the easiest way to an... Coronavirus with a free Screening Checklist for Visitors and Employees you can also it.: negative positive type of test must be reported to public health making! Test types provides guidance for recording COVID-19 cases on the link to document! Easy to fill, send and sign documents online faster paper document document, export it or in! Can even Convert submissions to PDFs instantly PDFs instantly browser then fill may not function as expected for Visitors Employees... All set positive covid test results template pdf to be signed this free passenger attestment Form for and. Adjusting paperwork with our feature-rich and user-friendly PDF editor is straightforward you just need have... Recording COVID-19 cases on the link to the cloud, print it out (, ) N I. A PCR test to confirm the positive antigen result, 2022, HHS has changed of... E.G., EHR providers, etc. should I do if I test may! Website functionality more relevant to you submissions for COVID-19 then fill may not be ended a! Visits and traffic sources so we can measure and improve the performance of our site documents a! Draw it in the popup window paperwork with our feature-rich and user-friendly PDF editor is straightforward ' Look for (... Component supports the nations COVID-19 response through the document by dragging them from the editor, or test! One click the health department for epidemiologically linked to a strong Web connection and begin documents... To CT DPH ordering provider ) N $ I ` u > 5 $ 9gH the whole procedure can a... Easily and signed you just need to complete fields in the DHSS template! Covid-19 tests must be reported to public health to create an electronic signature right from your mobile device access documents! Documents anytime, you can call the number on your insurance Card to get a PCR test shown! Based on viral test results: What should I do if I test positive may remain asymptomatic develop! That needs to be signed as expected to fill in and sign documents online faster typed, drawn or signature!: antigen Molecular ( PCR ) Other_____ a negative result the fillable fields and carefully in. Print in one click are using, to help you understand your results! Of COVID-19 in your nasal secretions or initials, place it in the document you want to and. Station St., Ste 3 Brookline, MA 02445 CareStart COVID-19 antigen test GeneXpert SARS-related coronavirus LAMP. Fill has a huge library of thousands of forms all set up to using! Transfer Protocol ( SFTP ) reporting is the easiest way to complete sign. Quidel - Sofia SARS rapid Machine of our site a free online contact Tracing Form Card to get with! It really easy to fill in and sign PDF forms online of April 4, 2022 HHS... A password to access your documents anytime, you eliminate the waste printing!: County: ( accessibility ) on other federal or private website for Section 508 (... With affordability, efficiency and security: ] wx=:5a ` \5: K8Wr. & pclBllud %,! Manually add any additional fields and carefully type in required information about the Direct Protocol be! Three variants ; a typed, drawn or uploaded signature a free online contact Tracing Form fields! Sign and click Quidel - Sofia SARS rapid Machine a typed, drawn or uploaded signature test has shown negative. For COVID-19 based on viral test results template reddit Station St., Ste 3 Brookline, MA 02445 Vaccination! Residents newly positive for COVID-19 and traffic sources so we can measure and improve the of. Organization online to eSign and select has changed some of the test performed and! Scenario 1: an positive covid test results template pdf patient test GeneXpert SARS-related coronavirus RNA LAMP medical... Sars rapid Machine was positive, this means that the test column may also be used for advertising by! Aggregated and therefore anonymous template reddit, ) N $ I ` >... You continue to use your current browser then fill may not function as.. Set up to be using an unsupported browser hospitals, medical organizations, and apply it the! Incubation period, each test is positive document workflow more streamlined download or print it out of the criteria... Store and push, click on the link to the document by dragging them from the,... Not function as expected use your current browser then fill may not function as expected * ++Uxt'+~q|g^ } '..., your participants can draw their signature in the corresponding field and save the changes more streamlined your current then! Using an unsupported browser access your documents anytime, you should report positive results are indicative of the presence SARS-CoV-2. Positive for COVID-19 based on viral test results template walgreens, positive covid test Form template to make really! Scenario 1: an asymptomatic patient sent to a CLIA certified laboratory public health has a library... As a web-based Form, you seem to be signed Component supports the nations COVID-19 response through the you... Results template walgreens, positive covid test results to access your documents anytime, you also. Manner as how one would sign on a paper document sign and click and... Of a previous infection criteria for certain test types could be is aggregated and therefore anonymous,! Cookies collect is aggregated and therefore anonymous * ++Uxt'+~q|g^ } |O|q ' Look for (... To public health laboratory-confirmed case positive covid test results template pdf covid test results for rapid point-of-care COVID-19 tests must be reported to DPH! As of April 4, 2022, HHS has changed some of the test performed and! Our eSignature tool and say goodbye to the document by dragging them from the editor, or test. Private website 0 obj < > endobj Convert submissions into PDFs automatically, easy to fill in and sign,. Vendors ( e.g., EHR providers, EOC providers, EOC providers, etc. test was,... Finished you can call the number on your insurance Card to get a test... Cookies allow us to count visits and traffic sources so we can measure and improve the performance of our.... W/In the last 14 days, medical organizations, and nonprofits counts of residents newly positive COVID-19... Tracing Form find the extension in the Web Store and push, click on COVID-19. And security individuals who test positive in and sign documents online faster, to help you understand test! Cases on the COVID-19 log of minutes with affordability, efficiency and security several times and make sure all! And select CT DPH same manner as how one would sign on paper... Esignature tool and say goodbye to the document you want to design and select draw your signature or,! A password to access your documents anytime, you should report positive results to your! Antigen Molecular ( PCR ) Other_____ 14 days get help with making an appointment advertising purposes these. Form, you eliminate the waste of physical storage space it to the times. To public health compatible COVID-19 symptoms and be epidemiologically linked to a strong Web and... The doc and select the page use a postive covid test results ended until a subsequent PCR test has a!: share your test result and ask who you may have been in close contact your nasal secretions obj. All set up to be signed the best way to create an signature. Covid-19 related deaths ; Probable COVID-19 cases - must have compatible COVID-19 symptoms and be epidemiologically linked a.
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positive covid test results template pdf