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  • Allegany County Department of Health

    POSITIVE COVID-19 HOME TEST REPORTING FORM
  • Please follow the manufacturer’s instructions to complete your at-home COVID-19 test.  Please remember to read the test results in the specified timeframe listed in the instructions for the at-home COVID-19 test. 

     

    If your test is positive use the form below to report your test results.  A new form must be completed for each household member who tests positive.  If there are any missing sections that are required on the form below, the form will be invalid. 

     

    *Do NOT submit this form if you tested negative.*

     

    Please isolate immediately and you will receive a call from a case investigator regarding your positive test. Depending on our caseload, it may be up to three (3) days before you are called.   Please answer the phone so we can reduce the spread of COVID-19. 

     

    * Required Fields

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  • By submitting this form, I attest that the information on this form is for a positive COVID-19 at-home test result and is my individual result or that of my minor child whose name is listed. All information is true and accurate.

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