Patient | Everywoman, Eve |
Patient ID(s) | PT-470124 2.16.840.1.113883.19.5
111-11-1111 2.16.840.1.113883.4.1 |
Contact info | Home:
1234 Patient Street New York City, NY 10012, US |
Date of Birth | December 12, 1995 |
Sex | Female |
Race | WHITE |
Ethnicity | Hispanic or Latino |
Primary Information Recipient: | Assigned, Amanda |
Contact info | Home:
1234 Provider Street New York City, NY 10012, US |
eICR Identifier: | 9408ddce-4dcb-416c-a153-82cce01839e2 |
Public Health Reporting Communication: one or more conditions are reportable, or may be reportable, to public health.
Your organization electronically submitted an initial case report to determine if reporting to public health is needed for a patient.
"Disease caused by severe acute respiratory syndrome coronavirus 2 (disorder)" is reportable to "New York City Department of Health and Mental Hygiene". The initial case report was sent to "New York City Department of Health and Mental Hygiene". Additional information may be required for this report.
"Disease caused by severe acute respiratory syndrome coronavirus 2 (disorder)" for "New York City Department of Health and Mental Hygiene"
Reporting is required immediately. Reporting to this Public Health Agency is based on "Both patient home address and provider facility address"
> This electronic case report serves as a TEST REPORT. Reporting for 2019 nCov is required immediately. While an electronic case report was sent on to NYC DOHMH, because the system is not in full production at this date, this report does NOT currently satisfy your reporting requirements. Please continue to report 2019 nCov using your normal methods. Click here to get information on how to report to the New York City Department of Health! (Immediate action required)
> CDC COVID-19 webpage (Information only)
> For more information or if you have any questions, please contact the New York City Department of Health at 1-866-692-3641