SCPS Positive Reporting Form
Please complete the following form if your student has tested positive AT A TESTING FACILITY. ONLY FILL OUT ONE FORM PER CHILD and be sure to choose the correct school. If your student has tested positive you will not receive a call from the school unless the nurse has questions. When you have completed the form, you should receive a confirmation that the form was submitted, if you did not, the form did not go through. You will receive a call from the health department within 72 hours. If you have not been contacted in 72 hours, please call 502-633-1243 ext. 122. Your student will need to email their teachers to make them aware of their absence so any school work can be provided virtually. If you need a laptop to complete virtual work (hot-spots will not be available), please contact the school and let them know. If you do not have an email address, you may provide your students school email address.
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Email *
School Student Attends/Nurse Email
Please select the email address for your school nurse. If you are unsure, please refer to the previous question. *
Student Name (First Last) *
Student Date of Birth *
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Parent Name (First Last) *
Parent Phone Number *
Street Address *
City *
Zip Code *
Date of Positive Test (day test was taken, not date the results came in) *
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Location of positive test (please be as specific as possible, ex: Norton Immediate Care Tyler Retail Village) *
Is the student currently showing symptoms? *
Required
What symptoms are present? *
Required
What date did the first symptom start? If no symptoms, type n/a *
What was the last day your student was present at school? *
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Does your student participate in school related extracurricular activities? If so, please explain. *
Does your student ride a bus? If so, which route number. If your student is a car rider/driver, please list any other students that ride to school with them that aren't in the household. *
Please list any students that sit within 6ft of your student at lunch, if your student does not know their names, you may enter "unknown". (This is for SCHS students only, if your student attends another school, enter "n/a") *
List any pre-existing conditions your student has and any daily medication taken for that condition. If none, put none. *
A copy of your responses will be emailed to the address you provided.
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