COVID-19 Investigation Form-English
If you have tested positive for COVID-19, please complete this form.
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Name: *
Date of Birth: *
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Complete Address (including city, state, zip-code): *
Phone Number: *
Test date *
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Test Location
Do you have any underlying Health Conditions: *
Required
If pregnant, what is your due date?
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Current Symptoms as of Today: *
Required
If symptoms resolved, what date did they resolve?
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Symptoms that you experienced on the first day you felt sick *
Required
If you never had symptoms, why did you get tested?
First day you started feeling sick (If you never felt sick, please put your test date): *
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Isolation period can be discontinued under the following conditions: 10 days after illness onset AND fever is gone AND symptoms have improved for the last 24 hours (1 days - can be within the 10 days). If you have met this criteria, you will not be contacted by SCPHD and are free from isolation.
Has it been 10 days since you started feeling sick? If you never felt sick, has it been 10 days from your test date? *
Would you like us to check in with you every day to see how you are doing and make sure your symptoms are improving?
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When and how would you like us to contact you, if you have not met the symptom criteria listed above?
8am
Noon
4pm
Text
Automated Phone Call
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Do you know where or how you were exposed to the coronavirus? *
Did you attend any public events or large private events in the 2 weeks before you became sick or while you were sick? *
If yes, describe event including date
Did you travel anywhere in the 2 weeks before you became sick? *
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