PatientEverywoman, 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 BirthDecember 12, 1995
SexFemale
RaceWHITE
EthnicityHispanic 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

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 "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