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.
Date of symptom onset:
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.)
Suspected (self-diagnosed, no lab results)
Probable (physician diagnosed, no lab results)
Confirmed by lab
Source of Illness:
Known exposure from local Orthodox community
Another known exposure (not from the local Orthodox community)
Unknown, but I work in a high risk occupation
Unknown, but I had an out-of-town interaction (i.e. travel or visitor)
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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