Report a diagnosis or exposure due to COVID-19
Students who have been diagnosed, symptomatic, or isolated due to COVID-19, please complete this form and a Health Services nurse will contact you within 24 hrs for follow up. 
Staff and Faculty with diagnosis need to report to Francys Rophol (x7571, francys.rophol@gcccd.edu) instead of filling out this form.
If you were exposed to COVID, you do not need to fill out this form or isolate. If you're a student and want information on what to do for exposure, please call 619-644-7192 or visit the SD County Public Health COVID page.
Sign in to Google to save your progress. Learn more
Name of person filling out this form: *
Are you a student? *
Student ID#:
Phone Number: *
Email Address: *
Select what applies: *
If you have taken a COVID test, upload a picture of the test result to the Medicat Patient Portal (https://gcccd.medicatconnect.com) with the following information: Photo ID, Birthday, Student ID#, and date of test. We cannot accept the test result if it does not have this information. 
If you are feeling symptoms, take a COVID test and upload it to the Patient Portal.
See example below.
 *
Make sure to register on the Patient Portal with the same email that you used to sign up for classes with.
Make sure to register on the Patient Portal with the same email that you used to sign up for classes with.
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms