Please fill out the following form completely if you have taken an at home COVID test and it was positive.  All information is needed to properly classify cases of COVID.  If you need to speak to someone about any questions that you might have please call us at (573)335-7846 and ask to speak to one of our contact tracers.  

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* 1. What is your first name?

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* 2. What is your last name

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* 3. What is your date of birth?

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* 4. What is your gender?

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* 5. What is your street address?

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* 6. What city do you live in?

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* 7. What is your phone number?

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* 8. What date did you take your at home test?

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* 9. Did you have any symptoms?

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