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FHC Covid Reporting Form

indicates a required answer

1. *

Parent Name

2. *


3. *

Phone Number 

4. *

Student name(s)

5. *

Are you reporting a COVID exposure or postive test?

Positive test Exposure
6. *

What was the date of exposure or positive test?

7. *

Does your student have symptoms? If yes, please describe (fever, runny nose, coughing, shortness of breath, aches, chills, etc.)

8. *

Your plans for testing are: 

PCR test ON/AFTER the 5th day from exposure Not testing, waiting 10 days after exposure
Already tested positive

Please provide us with any other relevant information here: