My Saginaw Health

I'm so sorry to hear that you've tested positive for COVID-19.

Make sure you call your healthcare provider to let them know you're positive so they can help manage your care!

You can prevent the spread to others by providing the following information. Your information is safe, secure and confidential and will only be used for management of your COVID-19 case.

Upon completion, I will provide you with your isolation completion date and, once verified, a letter to return to work/school plus other resources.

Everyone who tests positive for COVID-19, regardless of vaccination status, must:

Stay home for 5 days.
If you have no symptoms or your symptoms are resolving after 5 days, you can leave your house.
Continue to wear a mask around others for 5 additional days.

If you have a fever, continue to stay home until your fever resolves.

If you are the parent/guardian of a child who tested positive for Covid-19, please fill out this form on their behalf. If you and your child both tested positive, please fill out a form for each of you.

Let's get started. Help me learn more about you.

Your Contact Information

First Name

Middle Name

Last Name

Date of Birth

Street Address

City

County

State

Michigan

Zip

Cell Phone

Other Phone (if no cell)

Email Address

Parent/Guardian (if under 18)

Your Demographic Information

Sex at birth

Select an Option

Current Gender

Select an Option

Race (Check all that apply)

White or Caucasian

Black or African American

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Other (please specify)

If Other, Please Elaborate:

Hispanic Ethnicity

Arab Ethnicity

Are you employed?

Are you a student?

Do you attend daycare/childcare?

Select an Option

Do you live in a congregate setting (college dorm, group home, shelter, adult foster care, assisted living facility, long term care facility, rehab facility, or correctional facility)?

Select an Option

Great work!

You’re not quite done yet. I will provide you with a date when you can safely end isolation and leave your home once you complete the rest of this information.

Your Covid-19 Case Information

Date your symptoms began (if any)

Which of the following tests have you taken? (Check all that apply)

PCR

Rapid/Antigen

Date of PCR test

Date of Rapid/Antigen test

Do you know how you were exposed?

Select an Option

Are you part of a known outbreak?

Select an Option

What was your first full day of isolation at home?

Do you live with other people

Select an Option

In the 48 hours BEFORE symptom onset (or positive test if asymptomatic) up until the time you started staying home, did you visit any of these places?

Congregate setting (college dorm, group home, shelter, adult foster care, assisted living facility, long term care facility, rehab facility, correctional institution, etc.)

Healthcare setting.

University/school.

Childcare/daycare.

Large gathering/event (wedding, funeral, youth sports, religious service, concert, etc).

Have you completed your first Covid-19 vaccination series?

Select an Option

We can help notify any close contacts outside of your household who may have been exposed. Note: This is strictly confidential – we will never mention your name. If you provide the names and phone numbers of your close contacts, we will text them the following message: You've been exposed as a close contact to someone who has tested positive for COVID-19. Visit mysaginawhealth.org for clarification on whether or not you need to quarantine.

In the 48 hours BEFORE symptom onset (or positive test if asymptomatic) up until the time you started staying home, did you have any close contacts?

Select an Option

Note: close contact is within 6 feet of someone for 15 minutes or more within a 24-hour period. (If you’re a teacher/student, close contact is within 3 feet of someone for 15 minutes or more with a mask OR within 6 feet of someone for 15 minutes or more without a mask within a 24-hour period).

You’re done! Press “Submit” and I will provide you with important information about your case.