This HIPAA-compliant form should be completed by the person who has tested positive. Only in circumstances where the person cannot report themselves should someone else report on their behalf. The person should be aware you are making this report.
If you are symptomatic or have been exposed, please call the Health Center at 773-298-3712 or email Care Coordinator Anne Eastman-Kuziela at firstname.lastname@example.org.
If you are completing this report outside of business hours you will be contacted the next business day. Please wear a mask and stay home/in your room until you have been contacted.