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Town of Medfield: Positive Covid Case Report
* This is an optional case tracker and informational guide for members of the Medfield Community who have tested positive for COVID-19.
* All information is treated as confidential.
* CDC guidelines regarding isolation and quarantine will be sent to the email address provided below based on the dates you provided
* The town will not use the email provided for any other purpose.
* Once you submit the form, a copy of the information submitted will be sent to your email address.
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* Required
Email
*
Your email
Date of Positive COVID test
*
MM
/
DD
/
YYYY
What type of test was done?
*
At home rapid test
PCR test at healthcare/testing site
Not sure
Other:
Reason for Test
*
Symptomatic
Asymptomatic
Vaccination Status
*
Up-to Date - received all recommended covid-19 vaccinations plus booster if eligible; Fully Vaccinated → received primary series of COVID Vaccination; Partially Vaccinated → At least 1 vaccine shot
Up-to Date
Fully Vaccinated
Partially Vaccinated
Not Vaccinated
I prefer not to answer
What is the date that COVID symptoms began?
*
Symptoms include: fever, runny nose, cough, headache, fatigue with other symptoms, nausea/vomiting/diarrhea, shortness of breath, loss of taste/smell (if no symptoms, please enter date of positive test)
MM
/
DD
/
YYYY
Age
*
Age of person who tested positive
0 - 4
5 - 12
13 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70+
A copy of your responses will be emailed to the address you provided.
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