Patriot Elementary School                                 COVID-19 Student Test Submission Form
Sign in to Google to save your progress. Learn more
Email *
Student Test Submission Form
COVID-19 POSITIVE:
Students who tested positive for COVID-19 or are Exposed to COVID-19 can NOW return after 5 days of isolation or quarantine (previously 10 days) IF they return after 5 days of isolation or quarantine (previously 10 days) the following must be met:

Has been fever free for 24 hours without fever reducing medications, AND
Symptoms are resolved or resolving, AND
A NEGATIVE test collected on or after day 5

CLOSE CONTACT (EXPOSED TO AN INDIVIDUAL WHO TESTED POSITIVE)
Students who are exposed to a positive individual must begin their minimum of 5 day quarantine AFTER they have fully separated from the positive individual. Day 0 is the day of the student's last contact (exposure) with the infected person. Day 1 is the first full day after the close contact's last exposure. Students who are exposed to a positive person must begin their minimum 5-day quarantine AFTER they have fully separated from the positive person. Day 0 is the day of the student's last contact (exposure) with the infected person. Day 1 is the first full day after the last close contact exposure.

COVID-19 Symptoms/Sintomas del COVID-19:        
         - Fever or chills                    
         - Shortness of breath or difficulty breathing
         - Cough                                                                    
         - Fatigue
         - Runny nose or congestion                                                          
         - New loss of taste or smell
         - Sore throat                                                          
         - Muscle or body aches
         - headache                                                              
         - Nausea, vomiting or diarrhea

If your student is continuing to test positive for COVID-19 they must remain at home for the duration of the 10 day isolation.

Student's Last Name, First Name *
Parent's Last Name, First Name *
Teacher's Name *
Student's Grade Level *
Phone Number (XXX-XXX-XXXX) *
Reason for Negative Test Submission *
COVID-19 At Home Testing                                                                                              If you are using an iHealth IN HOME TEST please be sure to watch the following video to ensure the proper protocol is followed to ensure accurate results./Si está utilizando una PRUEBA EN EL HOGAR de iHealth, asegúrese de ver el siguiente video para asegurarse de que se siga el protocolo adecuado para garantizar resultados precisos.
Record Start Time of Test *
Time
:
Record End Time of Test *
Time
:
COVID- 19 Test Results:
COVID-19 Results - Email or presented to the school office. If you are providing the results from an IN HOME TEST, the photo of the test must include your STUDENT'S FULL NAME AND the DATE they took the test. Please write this information directly on the test. Please enter the date the test was administered.
MM
/
DD
/
YYYY
By clicking this box, I confirm I have assisted my student in following district Standard Quarantine and attest I have administered my STUDENT'S NEGATIVE COVID test results after five (5) days of required quarantine/isolation following the California Department of Public Health (CDPH) guidance. I will submit a picture of the test with my students name through email or to the school office.  I understand that the school office will confirm receipt of the test and notify me when my child is approved to return to school. Send picture of test to: twhite@ruesd.net 
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Rosedale Union School District. Report Abuse
Google Forms