You must self-isolate until you receive further instruction.
If your symptoms worsen, call 811. We are experiencing heavy call volumes and will get to your call as quickly as we can.
Call 911 if you are seriously ill and need immediate medical attention. Inform them that you may have COVID-19.
Please provide your contact information and healthcare number below. You will be called before the end of the week of March 22. A healthcare provider will determine if you need a nasal swab test.If you traveled with others who live in the same household as you, ONLY one form is needed.
AHS is a custodian with the authority to collect, use and disclose identifying health information, including healthcare numbers, under the Health Information Act. AHS is collecting and will use the information you provide to refer you to a healthcare provider for COVID-19 testing, notify you of the results (by telephone), and provide you with any additional instructions you need to follow. By submitting this form, you are acknowledging that you have been made aware of the purposes for which AHS will use and disclose your health information and authorizing its use and disclosure for those purposes. If you have questions about AHS’ authority or practices in relation to health information, please contact the Disclosure Help Line at 1.855.312.2265 or by email firstname.lastname@example.org. Alternatively, you can email email@example.com.