COVID-19 At Home Testing Report Form
This form is used for reporting individuals who tested positive for COVID-19, using an at-home test method.
Self-tests that are used without direct oversight by a medical provider are only for personal use. If the at-home result is positive, go to a medical facility or lab that performs molecular (PCR) tests. A positive molecular test result from a medical facility or lab confirms the infection and provides the necessary documentation that may prevent further testing and quarantine if there is another COVID-19 exposure within the next three months.

If the at-home kit does not have a system to report to public health, contact your local health department to report your results. This form should only be completed by Macomb County residents.

For more information visit Michigan.gov/coronavirus: https://tinyurl.com/At-Home-Testing

Note for completing this form:
-Person reporting is the person contacting Macomb County Health Department to notify of a COVID-19 case.
-Case is the person who tested positive for COVID-19.
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Email *
Name of Case
Case's Phone Number (Format: XXX-XXX-XXXX)
Case's Street Address
Case's City/Township of Residence
Case's Zip Code
Case's Date of Birth
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DD
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YYYY
Date of the positive test result
MM
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DD
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YYYY
Additional Comments
A copy of your responses will be emailed to the address you provided.
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