PatientAdam, Everyman
Patient ID(s)PT-470125 2.16.840.1.113883.19.5
333-33-3333 2.16.840.1.113883.4.1
Contact info Home:
0987 Home Street
Provo, UT 84601, US
Date of BirthSeptember 13, 1967
SexMale
RaceBlack or African American
EthnicityNot Hispanic or Latino
Primary Information Recipient:Hippocrates, Harold
Contact info Home:
1002 Healthcare Drive
Provo, UT 84601, US
eICR Identifier: 40fc3506-f9c2-45bf-a4f8-cbfe5cf744e8

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)