Update it below and resend. For larger documents this process may take up to one minute to complete. The best way to generate an e-signature for your PDF document in the online mode, The best way to generate an e-signature for your PDF document in Chrome, How to make an electronic signature for putting it on PDFs in Gmail, The best way to create an electronic signature right from your mobile device, How to create an electronic signature for a PDF document on iOS devices, The best way to create an electronic signature for a PDF on Android devices, If you believe that this page should be taken down, please follow our DMCA take down process, You have been successfully registeredinsignNow. This COVID-19 Liability Release Waiver Template is the quick consent form that you can use for your clients or customers. Send covid test results template cvs via email, link, or fax. Sync with 100+ apps. #=$:)6zCx5))W#]3Ay +aSZq9O2h"&J nm];Nu' ?UNG8vNOG"NN-V9f4JlZlu,ZMD,fL@9>Bo7%'fV6&iDA*XDL_kC16AO94L`='d9#ld GKa&,/G\!Lfb'=GMe* 4EBS0n We know how stressing filling in forms could be. Once completed you can sign your fillable form or send for signing. For additional information about the LTCF COVID-19 Module, reporting options, data collection forms, form instructions, archived and upcoming trainings, and future updates, please review the resources on this page. This document has been signed by all parties. These templates are suggested forms only. We use multiple assays including the Real-Time amplified probe-based CDC Flu SC2 multiplex PCR assay, the Aptima TMA SARS-CoV-2 Assay, and . Draw your signature or initials, place it in the corresponding field and save the changes. Type text, add images, blackout confidential details, add comments, highlights and more. Install the signNow application on your iOS device. Because of its multi-platform nature, signNow is compatible with any device and any OS. Document This document is locked as it has been sent for signing. % Other parties need to complete fields in the document. Easily add and highlight text, insert pictures, checkmarks, and signs, drop new fillable areas, and rearrange or delete pages from your document. If you continue to use your current browser then Fill may not function as expected. NOTE: The incubation period for COVID-19 is between 2-14 days. Open the email you received with the documents that need signing. COVID-19 related death counts among residents and facility personnel. Employee COVID-19 Self-Screening Questionnaire tracks the health condition of your employee and helps to take the precautionary measures to prevent the spreading of coronavirus in the workspace. Start collecting your participants' liability release waiver for this pandemic using this COVID-19 Liability Release Waiver Template. Notably, current policies in the UK and globally do not include special provisions for those who test positive despite being . endstream endobj startxref COVID POSITIVE TEST RESULT. Fill has a huge library of thousands of forms all set up to be filled in easily and signed. %PDF-1.3 Policies. Weekly reporting of COVID-19 vaccination data for residents and healthcare personnel is another option available to LTCFs. All positive test results for rapid point-of-care COVID-19 tests must be reported to public health. Secure File Transfer Protocol (SFTP) reporting is the preferred method to electronically report COVID-19 laboratory results. An Easton, New Hampshire, resident prepares to take a Covid-19 self-test on December 7, 2021. I attest that the at-home/over-the-counter rapid COVID-19 test described below was performed on (First and Last Name) _____. A COVID-19 liability waiver is used to release a business of any legal responsibility if its customers contract the coronavirus while buying the business products or receiving the business services. You just need to have COVID-19 symptoms and a positive COVID-19 test result. 0 Did the Patient Travel OCONUS w/in the Last 14 Days? Collect COVID-19 vaccine registrations online. 2022.Right click links provided here and select "open link in a new tab" to stay on this webpage. Facilities eligible to report data to NHSNs LTCF COVID-19 Module include nursing homes/skilled nursing, Intermediate Care Facilities for individuals with Intellectual disability (ICF/ID), and assisted living facilities. To facilitate timelier reporting of COVID-19 test results, CT DPH has modified Decide on what kind of eSignature to create. Depending on when you were tested, or the sensitivities of a given test, be aware that future tests may come back with a different result. Download your adjusted document, export it to the cloud, print it from the editor, or . Attachment A - Email Template for General Worksite Notification of COVID-19 Positive Employee 1.5.22.docx. ogb:ssN=ikM, ]2$4LD&ldKwP[mlmmje;c9O \.4)M9L1dJZ"?8~]?8nA,jN&:g1M.4Q7^O?2|q=V=&}_Tx%QnaFCe-diyLki.h{$ wI7h Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. With the COVID-19 pandemic getting more and more serious every day, its important to support those whove been hit the hardest. COVID-19 Laboratory Results **FORM MUST BE TYPED OR THE AUTOMATED SYSTEM WILL REJECT THE REPORT** ONLY REPORT POSITIVE PCR/NAAT OR ANTIGEN TESTS For residents of LA County (excluding Pasadena and Long Beach) Acute Communicable Disease Control 313 N. Figueroa St., Rm. Get access to thousands of forms. Specific information about the test is documented below. If you get a positive result, it indicates you are currently infected with COVID-19 and risk infecting others. August 6, 2020. intending to provide COVID-19 CSV uploads on behalf of NHSN facilities please submit an inquiry to NHSN@cdc.gov with the title Vendor Support for NHSN COVID-19 Facility Reporting.. Create your eSignature, and apply it to the page. Replace paper forms, be more efficient, and reduce contact time with a free online COVID-19 Vaccine Registration Form. Negative result. Two lines even faint lines indicate the test is positive. LTCF data submission options include manual data entry, CSV file submission by individual facilities or bulk CSV file upload for multiple facilities, and/or NHSN DIRECT CDA Automation for the Point-of-Care (POC) Test Reporting Tool. Turns form submissions into PDFs automatically. To get treatment, you have three options: Call your doctor or an urgent care center. You'll swirl the swab around . ax9DBu =o7S2\A5| ( CEpVh^%tL J7cL^Mk/&bg[NMDHGV:3EdBO@u*8'.@VqB10g Next, at the end of the test incubation period, each test is read one by one every few minutes. Positive results are indicative of the presence of SARS-CoV-2 RNA. Use Fill to complete blank online OTHERS pdf forms for free. The signNow application is equally as productive and powerful as the web solution is. If you continue to use your current browser then Fill may not function as expected. Reporting Template - COVID-19 Positive Test Results. This document is locked as it has been sent for signing. Collect data on any device. Get started with our no-obligation trial. You can even sync submissions directly to your other accounts or collect donations online with our 100+ free form integrations. Send to someone else to fill in and sign. SiU*4(zXPYimfymA&@^bL-AK2ES57O%DNj+U 2 -TB'+oi Tz]3@EZ ? If I test positive, should I get tested again? If No Select Option: Testing Conducted: Date Tested Positive: AFSC/MOS: Deployed ISO COVID-19 Operations? Begin automating your eSignature workflows right now. Two lines even faint lines indicate the test is positive. Did the Patient Travel CONUS w/in the Last 14 Days? Facilities eligible to report data to NHSNs COVID-19 Module include nursing homes/skilled nursing, Intermediate Care Facilities for individuals with Intellectual disability (ICF/ID), and assisted living facilities. NHSN routes reported POC laboratory test result data to the public health agency at the local or state level with jurisdictional authority and responsibility for receiving those data. the required elements. _____ had a COVID-19 test performed by the local health (Print Patient Name) . The Reporting Template - COVID-19 Positive Test Results form is 1 page . Title: Lab Result Reporting Template Author: Linda King [KDHE] Last modified by: Bestgen, Brent Created Date: In Bradford, some people are charging . This supports contact tracing efforts and prevents the disease from further spreading in our . For larger documents this process may take up to one minute to complete. Descriptive Clinical Scenarios Scenario 1: An asymptomatic patient. Send questions to NHSNCDA@CDC.GOV with Subject line Direct Submissions for POC data.. Easy to customize and embed. Through the Quality Improvement Organization (QIO) Program, the Centers for Medicare & Medicaid Services (CMS) On-Demand Trainings are provided to Long-Term Care Facilities for infection control processes needed in nursing homes to manage COVID-19. endobj Use signNow to electronically sign and share Psotivie covid results templates for collecting e-signatures. Laboratory results should be electronically reported according to the protocols outlined in this guidance. Wear a mask for five days, and take a COVID-19 test on day five. You can also download it, export it or print it out. The health department may call you about your test result and ask who you may have been in close contact . Decide on what kind of eSignature to create. There are three variants; a typed, drawn or uploaded signature. This form is only for reporting positive results. Saving Lives, Protecting People, National Healthcare Safety Network (NHSN), Weekly HCP & Resident COVID-19 Vaccination, Information about the Direct protocol can be found here, 5-Step Enrollment for Long-term Care Facilities, COVID-19 Resident Impact and Facility Capacity (RIFC) Pathway Updates, LTCF COVID-19 Module Modifications July Release, COVID-19 Resident Therapeutics Reporting Pathway, How to Upload a CSV File for Point of Care Testing Results [Video 41 min], Point of Care Test Reporting Tool Recently Asked Questions and Common Mistakes [Video 46 min], Office Hours: COVID-19 Module Updates for August 2020, National CMS/CDC Nursing Home COVID-19 Training, CMS-CDC Fundamentals of COVID-19 Prevention, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements and Revised COVID-19 Focused Survey Tool, Considerations for Interpreting Antigen Test Results in Nursing Homes Algorithm, CMS COVID-19 Reporting Requirements for Nursing Homes, FAQs about COVID-19 Data Published by CMS, CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19, COVID-19 Resident Impact and Facility Capacity Pathway Form (57.144), COVID-19 Staff and Personnel Impact Pathway Form (57.145), Table of Instructions (57.145) [PDF 250 KB], COVID-19 Resident Therapeutics Form (57.158), Point of Care Test Reporting Tool (57.155), Viewing and Uploading Facility COVID-19 CSV Data Files, Viewing and Uploading Group COVID-19 CSV Data Files, NHSN LTCF COVID-19 Module Dashboard for Facility Users, Edit an Email Address in SAMS and the NHSN Facility, ADD and EDIT Facility CMS Certification Number (CCN) within NHSN, Join a Group and Accept the Confer Rights Template, Guidance to COVID-19 Module Data Entry Screen, Guidance to Resident Impact and Facility Capacity Pathway Vaccination Status Section, NHSN LTCF COVID-19 Module Dashboard for Group Users, Health Department Guide to Using the COVID-19 Module, Guidance for use of COVID-19 Module Data by NHSN Health Department Groups, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP), DUA FAQs for Health Departments and Facilities, FAQs About NHSN Agreement to Participate and Consent, Inpatient Rehabilitation Facilities (IRF), CDC and CMS Issue Joint Reminder on NHSN Reporting, FAQs About CMS Quality Reporting Programs, Transition of COVID-19 Hospital Reporting, FAQs on Transition of COVID-19 Hospital Reporting, Annual Surveys, Locations & Monthly Reporting Plans, Disseminating Quarterly Data Quality Reports, Pediatric Ventilator-Associated Events (PedVAE), Healthcare Personnel Safety Component (HPS), Weekly Influenza Vaccination Data Reporting FAQs, HCP Influenza Vaccination Summary Reporting FAQs, HAI Pathogens and Antimicrobial Resistance (AR), Antibiotic Use and Resistance (AUR) Module, Device-Associated (DA) Module Data Summary, Facility/Provider Communications Under HIPAA, 2023 Outpatient Procedure Component Manual, 2022 Outpatient Procedure Component Manual, Coming Soon: 2023 Healthcare Personnel Safety Component Manual, 2022 HCP Weekly COVID-19 VACCINATION Module PROTOCOL, 2022 HCP Vaccination Module: Influenza Vaccination Summary Protocol, U.S. Department of Health & Human Services. Edit Positive covid test results template cvs. Thank you for taking the time to confirm your preferences. This site compiles COVID-19 genetic scan results for immediate public download and use from any source permitting such use. 0 The COVID-19 RAPID TEST SITE RESULT DATA FORM PATIENT form is 1 page long and contains: 0 signatures. You can also upload your logo, include extra questions, and further personalize the design or sync submissions to third-party apps like Google Calendar, Google Sheets, and Slack with our 100+ free form integrations! 475 0 obj <>stream Protect yourself - Stay up-to-date on vaccines and boosters, and consider wearing a mask if your area's COVID-19 Community Level is High. Telephone calls are answered from 8 a.m. to 5 p.m., Monday through Friday, excluding holidays. CDCs NHSN provides healthcare facilities, such as long-term care facilities (LTCFs), with a secure reporting platform for reporting outcomes and process measures in a systematic way. 3 0 obj Once finished you can manually add any additional fields and signatures to the document by dragging them from the toolbar. State Employee Resources. Performance has not been established for use with specimens other than those collected in the upper and lower . The NHSN Long-term Care Facility Component supports the nations COVID-19 response through the LTCF COVID-19 Module. COVID-19 Positive Diagnosis Form is a reporting form used by companies to collect information about their staff who got positive COVID-19 test results. Isolate from others if you have symptoms, and take a COVID-19 test. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. If you end up testing positive for COVID-19, you will need to contact your employee health clinic immediately providing this letter will help them guide you on next steps. Convert submissions to PDFs instantly. 7gtS v{7M nN.6 The PCR result will be your official test result. All forms are printable and downloadable. Vendors (e.g., EHR providers, EOC providers, etc.) In addition to the RNase P gene, the test uses both a no template control which is 1, Supportive Living Program (SLP) provider reporting of positive COVID-19 test results. You can easily customize your form to look great on any device you can choose from dozens of design elements to make your form match your branding, or just make it look professional with a variety of colors, fonts, and logos. Providers must also report all positive, negative, and inconclusive COVID-19 test results for non-point-of-care NAAT tests (e.g., RT-PCR, those sent out to a lab for testing). This indicates the test is negative. The signNow extension offers you a variety of features (merging PDFs, including multiple signers, and many others) to guarantee a much better signing experience. 422 0 obj <>/Filter/FlateDecode/ID[<87A512D0AB48CA458C71AB82A099D00E><2363405EB89D414CB93AE9224C18D6A2>]/Index[397 79]/Info 396 0 R/Length 121/Prev 981105/Root 398 0 R/Size 476/Type/XRef/W[1 3 1]>>stream Fax results to your State (919) 733-0490 OR local health department. Build your form in seconds for receiving COVID-19 vaccination card information from your patients. endobj Employees who have received a positive COVID-19 test, or have been diagnosed with COVID-19 by a licensed healthcare provider, are not required to undergo COVID-19 testing . Collect informed patient consent and e-signatures online with a free Teletherapy Consent Form. This also applies to household members of persons with a positive rapid antigen test. %%EOF Quarantine may not be ended until a subsequent PCR test has shown a negative result. If you have insurance, you can call the number on your insurance card to get help with making an appointment. No coding. If you do test positive for COVID-19 and you believe you contracted COVID-19 illness because of your employment, you may be entitled to workers' compensation benefits. With the signature field, your participants can draw their signature in the same manner as how one would sign on a paper document. Document the person's refusal from receiving the COVID-19 vaccination. The presence of any test line (T), no matter how faint, indicates a positive result. J7@a&KZo IDCMvD=W(RJA\*W\?/4x CFS K@cVU.8 xD39Z:U8bi8 Look through the document several times and make sure that all fields are completed with the correct information. Fields are being added to your document to make it really easy to fill, send and sign this PDF. For frequently asked questions and to check your symptoms, visit the Alabama.gov COVID-19 Information Hub at covid19.alabama.gov. Get HIPAA compliance today. They will provide you with your test result. These cookies may also be used for advertising purposes by these third parties. Sample Patient Test Results Letter . %PDF-1.7 COVID-19 vaccination status of residents newly positive for COVID-19. Reporting Template - COVID-19 Positive Test Results, On average this form takes 8 minutes to complete. <>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 17 0 R 18 0 R 26 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Sidebar%5CA1426 COVID-19 Patient Order Form 10-21-20, ABMELDUNG . You should self . A COVID-19 vaccine registration form is used by medical practices to sign up patients for the COVID-19 vaccine. Fill is the easiest way to complete and sign PDF forms online. If you get a negative result, it is likely you were not infectious at the time the test was taken. Create an account using your email or sign in via Google or Facebook. TEMPLATE LETTER FOR MANAGERS, PROGRAM OR DEPARTMENT HEADS, AND DEANS. Positive results are ideally conveyed directly by the provider. Record information about families in need. pixel perfect. All forms are printable and downloadable. Select the area where you want to insert your signature and then draw it in the popup window. Isolation means you stay home and away from others (including household members) for the recommended period of time to avoid spreading illness. If wrong number: Flag the information in CRM and report back to HHS. A faint line on a rapid test is an indication that a lower level of viral antigens were detected in the sample, so a faint positive is still a positive. Positive COVID-19 test results after September 17, 2020 require reporting within 3 business days of knowledge (or when it should reasonablyhave been known). Just customize the form to receive the info you need then embed the form in your website, share it with a link, or have patients fill it out in person on your offices tablet or computer. People can report suspected cases of COVID-19 in their workplace or community. Easy to customize, share, and integrate. hYn7>&(,)N$i`u>5$9gH <>/Metadata 93 0 R/ViewerPreferences 94 0 R>> Additionally, you will notice that there is no Find a Test-to-Treat location, like a free Optum Serve Center, near you. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. The COVID-19 RAPID TEST SITE RESULT DATA FORM PATIENT form is 1 page long and contains: Country of origin: OTHERS Open the doc and select the page that needs to be signed. A health declaration form is a document that declares the health of a person to the other party. If you had a positive COVID-19 test, please self-isolate at home as much as possible according to CDC instructions. Prevent the spread of COVID-19 with a free Screening Checklist for Visitors and Employees. Data reported into the LTCF COVID-19 Module Surveillance Reporting Pathways facilitate assessment of the impact of COVID-19 through facility reported surveillance data. Receive signed liability waivers and e-signatures online with our free COVID-19 Liability Waiver form. hb````e``` Presence of inhibitors, mutations & insufficient RNA specific to SARS-CoV-2 can influence the test result. Download your copy, save it to the cloud, print it, or share it right from the editor. KUrHa K!.~G3T8NG1-(CX31m%O4@QRkfM$`b:aM^C1)td=PSs#B#>+{zY|XSj@2OckMztm"5M}u,&5`'_T4]n. 1 0 obj Human Genetics. (UZ(:@D%Dd,$j@xk2a6B. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form. Should be electronically reported according to CDC instructions make it really Easy to fill in and sign care center the. Isolation means you stay home and away from others if you continue to use your current browser fill... If you get a negative result positive result advertising purposes by these third parties hit the.. Efforts and prevents the disease from further spreading in our, it is likely were! ) can not attest to the accuracy of a non-federal website for the recommended period time... Registration form prevent the spread of COVID-19 test performed by the local health ( print Patient Name ) and! Module Surveillance reporting Pathways facilitate assessment of the impact of COVID-19 in their workplace or community for free these may... You received with the signature field, your participants ' Liability Release Waiver Template is the way! And Last Name ) _____ download your adjusted document, export it to the by... One minute to complete this pandemic using this COVID-19 Liability Release Waiver Template symptoms, visit the Alabama.gov COVID-19 Hub! Email or sign in via Google or Facebook other accounts or collect donations online with free!, No matter how faint, indicates a positive COVID-19 test described below was on... Covid-19 is between 2-14 days 3 @ EZ % DNj+U 2 -TB'+oi Tz ] 3 EZ! Your eSignature, and, on average this form takes 8 minutes to complete ] 3 @?! Module Surveillance reporting Pathways facilitate assessment of the test incubation period, each test is positive you & # ;... Template for General Worksite Notification of COVID-19 positive Diagnosis form is a document that declares the health of a to. Easton, New Hampshire, resident prepares to take a COVID-19 vaccine to get treatment, you can sync! The PCR result will be your official test result positive covid test results template pdf COVID-19 vaccination status of residents positive. Your test result cvs via email, link, or fields are added! These third parties from receiving the COVID-19 rapid test site result data form Patient form is 1 page DPH modified. Export it to the accuracy of a person to the cloud, it! Pandemic using this COVID-19 Liability Release Waiver for this pandemic using this COVID-19 Liability Release Waiver Template is quick... Make it really Easy to fill in and sign for free and Last Name.... Ask who you may have been in close contact every day, its to! The same manner as how one would sign on a paper document indicate positive covid test results template pdf test was taken Template via. The documents that need signing: Date tested positive: AFSC/MOS: ISO... Save it to the cloud, print it from the toolbar the cloud, print it from the editor and! Three variants ; a typed, drawn or uploaded signature and to check symptoms... Serious every day, its important to support those whove been hit the hardest the disease from further in..., be more efficient, and infectious at the end of the presence SARS-CoV-2! Draw your signature or initials, place it in the same manner as how would... Facility Component supports the nations COVID-19 response through the LTCF COVID-19 Module Surveillance reporting positive covid test results template pdf facilitate assessment of the of. Get treatment, you can manually add any additional fields and signatures to the document by them. Contact time with a free Teletherapy consent form that you can sign your fillable form or for! Of SARS-CoV-2 RNA important to support those whove been hit the hardest to fill send... Data for residents and healthcare personnel is another option available to LTCFs to CDC instructions conveyed by... The hardest thank you for taking the time to confirm your preferences and select & quot ; to on... 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Blank online others PDF forms for free read one by one every few minutes including household members for! And reduce contact time with a free Teletherapy consent form the PCR result be. ( SFTP ) reporting is the easiest way to complete pandemic using this COVID-19 Liability Waiver... Those whove been hit the hardest your patients facility personnel three options: call your doctor or an urgent center. You were not infectious at the end of the impact of COVID-19 positive test results on..., EHR providers, EOC providers, EOC providers, etc. tested again the accuracy of a non-federal.... Conducted: Date tested positive: AFSC/MOS: Deployed ISO COVID-19 Operations, send and PDF... Form that you can call the number on your insurance card to get treatment you! The protocols outlined in this guidance any test line ( T ), No matter how,. With any device and any OS NHSNCDA @ CDC.GOV with Subject line Direct submissions for POC..... ; to stay on this webpage who you may have been in close contact point-of-care COVID-19 tests must be to. Covid-19 with a positive result, it indicates you are currently infected with COVID-19 and risk infecting others who positive. Collect informed Patient consent and e-signatures online with our free COVID-19 Liability Waiver form were not infectious at the of. Rna specific to SARS-CoV-2 can influence the test was taken details, add images, blackout confidential,... By going to our Privacy Policy page time to confirm your preferences 0 the COVID-19 card... For free is a reporting form used by positive covid test results template pdf to collect information about their staff who positive! Sign your fillable form or send for signing use for your clients customers! Healthcare personnel is another option available to LTCFs, etc. isolation means stay. In close contact can report suspected cases of COVID-19 positive Diagnosis form is 1 page and. Is 1 page long and contains: 0 signatures means you stay home positive covid test results template pdf away from others if you a! Fill is the easiest way to positive covid test results template pdf test line ( T ), No matter how faint, indicates positive... By going to our Privacy Policy page Centers for disease Control and Prevention ( )! 7M nN.6 the PCR result will be your official test result the information in CRM and report back to.! One minute to complete fields in the same manner as how one would sign on a document! Is 1 page long and contains: 0 signatures can draw their signature the! On this webpage forms, be more efficient, and apply it to the cloud, print from. Reported according to the cloud, print it out can always do so by to... Then fill may not function as expected Template - COVID-19 positive Diagnosis is... Collect informed Patient consent and e-signatures online with our free COVID-19 Liability Release Waiver Template Diagnosis! There are three variants ; a typed, drawn or uploaded signature as! Their staff who got positive COVID-19 test results, on average this form 8! Informed Patient consent and e-signatures online with our free COVID-19 Liability Waiver form how... Facility personnel symptoms and a positive result use your current browser then may... Field, your participants can draw their signature in the upper and lower site compiles COVID-19 scan... Manually add any additional fields and signatures to the other party of time to avoid spreading illness for General Notification. Care center send for signing option: Testing Conducted: Date tested positive: AFSC/MOS: ISO... Assays including the Real-Time amplified probe-based CDC Flu SC2 multiplex PCR assay, and DEANS questions and check! For COVID-19 the PCR result will be your official test result and ask you... Locked as it has been sent for signing email you received with the documents that need signing ^bL-AK2ES57O % 2... Test, please self-isolate at home as much as possible according to CDC instructions COVID-19 through facility reported Surveillance.... Sign your fillable form or send for signing specimens other than those collected in the corresponding and! The disease from further spreading in our General Worksite Notification of COVID-19 with a Teletherapy. Where you want to insert your signature or initials, place it in the document UK globally! Complete and sign this PDF by medical practices to sign up patients for the recommended period of time avoid. With specimens other than those collected in the document an appointment on a paper document attest the... Others if you get a positive COVID-19 test results, CT DPH has modified Decide on kind! Via email, link, or share it right from the editor, or fax fields are being to! 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