PatientKarri, Kid
Patient ID(s)PT-470123 2.16.840.1.113883.19.5
555-55-5555 2.16.840.1.113883.4.1
Contact info Home:
2222 Home Street
Salt Lake City, UT 84101, US
Date of BirthOctober 27, 2002
SexFemale
RaceAsian
EthnicityNot Hispanic or Latino
Primary Information Recipient:Seven, Henry
Contact info Home:
1234 Provider Street
Salt Lake City, UT 84101, US
eICR Identifier: e91bc1e8-2523-4047-a663-1e3e07812948

Subject:

Public Health Reporting Communication: one or more conditions are reportable, or may be reportable, to public health.

Summary:

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 "Utah Department of Health". The initial case report was sent to "Utah Department of Health". Additional information may be required for this report.

"Disease caused by severe acute respiratory syndrome coronavirus 2 (disorder)" for "Utah Department of Health"

Reporting is required immediately. Reporting to this Public Health Agency is based on "Both patient home address and provider facility address"

> CDC COVID-19 webpage (Information only)

> Public Health Agency Contact Information (Information only)

Additional Resources:

> (Information only)