PatientPatient, Joseph
Patient ID(s)PT-470127 2.16.840.1.113883.19.5
222-22-2222 2.16.840.1.113883.4.1
Contact info Home:
2222 Home Street
Sacramento, CA 94203, US
Date of BirthJuly 30, 1989
SexMale
RaceAmerican Indian or Alaska Native
Ethnicity Not Hispanic or Latino
Primary Information Recipient:SanDiego, Carmen
Contact info Home:
1234 Provider Street
Sacramento, CA 94203, US
eICR Identifier: 38e6a983-38ad-484f-a7d2-b294cdbe5435

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

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

> Local Health Department Contact Information (Information only)