Consent for COVID-19 Sharing of Information
This form will provide us with consent or refusal to share student information with DHMC for the purposes of rapid and efficient contact tracing and testing.
Email address *
The Grantham School District has been working with local medical providers to improve the process for conducting COVID-19 testing and contract tracing if needed for potential exposures among students and members of our school community. The New Hampshire Department of Health and Human Services (NHDHHS) already has a process to complete their contact tracing investigations per their own protocols, but we are also developing a separate but complementary process with Dartmouth-Hitchcock Medical Center (DHMC) that we believe will streamline the process and give our families more rapid access to testing. We have a unique opportunity to leverage the advantage of having these wonderful resources close by and therefore want to partner with them to ensure our school community’s safety, alleviate unnecessary anxiety if/when we have a positive case, and streamline the isolation/quarantine/testing process to keep school running smoothly. As some of you may already know, currently it can take up to 72 hours for NHDHHS to make contact with families to start the testing and contact tracing process. Our goal is to reduce unnecessary lag by allowing the schools to provide information directly to the Dartmouth-Hitchcock COVID-19 hotline for testing as well as the other schools with whom Grantham shares students for tracing. Allowing the school to provide information directly to the Dartmouth-Hitchcock COID-19 Hotline will enable the Hotline to directly contact families to schedule testing, and should also result in parents receiving test results more quickly. This will limit the frustration of families needing to schedule this themselves as individuals and allow D-H to better coordinate these groups needing testing. Your family does not need to have a primary care doctor at DHMC in order to have testing completed there in response to a school exposure. Additionally, this process should also result in faster contract tracing through the schools. This process will help us accomplish our shared goals of allowing schools to remain open while stopping the virus from spreading. We ask that you authorize the Grantham School District to disclose your child’s name and family contact information directly to the D-H COVID-19 Hotline in the event of a potential COVID-19 exposure, in order to enable scheduling of testing and to expedite the testing process. Further, we ask that you authorize the Grantham School District and any school district (e.g., Lebanon) to exchange such information regarding any Grantham student who attends and/or whose sibling or household member attends school in such other district. Such information will be shared ONLY with DHMC, NHDHHS, and the other District (e.g., Lebanon School District if a sibling or household member attends at LMS or LHS) for the sole purpose of COVID-19 testing and contract tracing, and will otherwise remain confidential. Thank you so much in advance for your cooperation and consent. Please click below that you have read this information. *
Family Last Name(s)
Children living in your household attending GVS
Children living in your household attending LMS and/or LHS
I give the Grantham School District permission to share this information. *
By typing my name in the box below, I am giving my electronic signature.
Never submit passwords through Google Forms.
This form was created inside of Grantham Village School. Report Abuse