COVID-19 At-Home Self Report Tool
TCHD will send an informational packet to each positive case via USPS.  Failure to complete this form in its entirety may result in delays or our inability to send you information.  Contained in the packet will be a form titled "Documentation of COVID-19 Positive Test".  This form may be used for return to work or school, if needed.

Please note: This is for residents of Tuscarawas County, who reside outside the city limits of New Philadelphia.  New Philadelphia City residents should contact the New Philadelphia City Health Department to self report.
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Name of person testing positive: *
Date of birth of person testing positive: *
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Date test was taken *
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Full Mailing Address (please include the city and zip code).                                                                                                Failure to complete this section will result in our inability to send you a release for work/school. *
Phone Number *
Signature/Guardian Signature - I hereby certify that the information is true and accurate and I confirm that I want to submit this lab result on behalf of myself or the minor identified on this form. (Please enter full name of person completing this form for Signature) *
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