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Hedgcoxe Elementary COVID Reporting Form
2022-2023 COVID Reporting form
Please complete a form for each child that has a confirmed positive covid test.
Thank you,
Amanda Robison, RN, CPN
School Nurse
Hedgcoxe Elementary
amanda.robison@pisd.edu
469-752-1709
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* Indicates required question
Child's Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Student ID number
Your answer
Date of Positive test result
*
MM
/
DD
/
YYYY
Please select the type of COVID test
*
Rapid home test
Rapid COVID test in office/testing site
PCR test
Other:
Date symptoms began
*
MM
/
DD
/
YYYY
Symptoms present
*
Fever
Cough
Runny nose
Nausea, Vomit and/or Diarrhea
Other
Required
Best Daytime Phone Number
*
Your answer
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