I tested positive for COVID-19 and am in Isolation.
- IF SYMPTOMATIC
- At least 24 hours have passed since recovery, defined as resolution of fever without the use of fever-reducing medications; AND
- My respiratory symptoms (e.g., cough, shortness of breath) have improved; AND
- At least 10 days have passed since my symptoms first appeared.
- IF ASYMPTOMATIC
- At least 10 days have passed since the date of my COVID-19 diagnostic test; AND
- I have had no subsequent illness.
Applicant E-Mail/Electronic Communication Consent for NCDOH to Respond to COVID-19 I&Q Order Request
I acknowledge and consent as follows:
- I acknowledge that commonly used e-mail services are not secure and fall outside the security requirement set forth by the Health Insurance Portability and Accountability Act for the transmission of protected information.
- I understand there is a risk that my health information may be obtained by others.
- I release the County of Nassau from any liability that might arise from transmission of a Letter of Release from Isolation or Quarantine through electronic means to the email address I have provided.
- I authorize Nassau County Department of Health to transmit my personal health information (Response to Request for COVID-19 Release from Isolation/Quarantine Order) via email even though email may not be secure and private and may be subject to loss or exposure.
My child (under 18 years old) tested positive for COVID-19 and is in Isolation.
- IF SYMPTOMATIC
- At least 24 hours have passed since my child 's recovery, defined as resolution of fever without the use of fever-reducing medications; AND
- Their respiratory symptoms (e.g., cough, shortness of breath) have improved; AND
- At least 10 days have passed since their symptoms first appeared.
- IF ASYMPTOMATIC
- At least 10 days have passed since the date of my child 's COVID-19 diagnostic test; AND
- They have had no subsequent illness.
Applicant E-Mail/Electronic Communication Consent for NCDOH to Respond to COVID-19 I&Q Order Request
I acknowledge and consent as follows:
- I acknowledge that commonly used e-mail services are not secure and fall outside the security requirement set forth by the Health Insurance Portability and Accountability Act for the transmission of protected information.
- I understand there is a risk that the health information may be obtained by others.
- I release the County of Nassau from any liability that might arise from transmission of a Letter of Release from Isolation or Quarantine through electronic means to the email address I have provided.
- I authorize Nassau County Department of Health to transmit my child's personal health information (Response to Request for COVID-19 Release from Isolation/Quarantine Order) via email even though email may not be secure and private and may be subject to loss or exposure.
My child (under 18 years old) was in close or proximate contact to an individual who tested positive for COVID-19 and is in Quarantine.
- My child has had no symptoms (fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea) during the quarantine period.
- I agree to continue daily symptom monitoring of my child for Fourteen (14) Days from the last date of close contact with a confirmed or suspect COVID-19 case; AND
- I agree to continue to monitor my child 's strict hand hygiene and the use of face coverings through Day 14; AND
- I agree that if my child develops any symptoms, I will immediately isolate my child and contact my healthcare provider to report this change and determine if I should seek COVID-19 testing for my child .
Applicant E-Mail/Electronic Communication Consent for NCDOH to Respond to COVID-19 I&Q Order Request
I acknowledge and consent as follows:
- I acknowledge that commonly used e-mail services are not secure and fall outside the security requirement set forth by the Health Insurance Portability and Accountability Act for the transmission of protected information.
- I understand there is a risk that the health information may be obtained by others.
- I release the County of Nassau from any liability that might arise from transmission of a Letter of Release from Isolation or Quarantine through electronic means to the email address I have provided.
- I authorize Nassau County Department of Health to transmit my child's personal health information (Response to Request for COVID-19 Release from Isolation/Quarantine Order) via email even though email may not be secure and private and may be subject to loss or exposure.
