Atlanta Synagogue COVID Alert Network
Please fill out the requested information to help local synagogues track trends in COVID-19 cases in the Jewish community.
Today's date: *
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Date of symptom onset: *
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What is the zip code of your residence? *
Is this case: *
(There is no need to resubmit a new form later if you get new test results after completing this one.)
Source of Illness: *
May the rabbi/designee contact you if additional information is needed? (this is particularly important if there have been several cases in your home). If so, please indicate "yes" on the line below, along with your name, phone number, &/or email address. (In certain situations the Health Department may contact the case through its legal public health authority.)
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