[Guilford County, NC] COVID Reporting

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COVID Reporting – Medical Practices

Please use this form to report known positive COVID cases to the Guilford County Division of Public Health. If you are a healthcare provider, please ensure that you are uploading the current Disease Reporting Form as required by state law.

Health Agency Making Report

Business Name

Patient Name

Gender

Male

Female

Ethnicity

Hispanic

Non Hispanic

Race

Asian

Black

American Indian / Alaskan Native

Pacific Islander / Hawaiian

White

Decline to Answer

Patient Phone Number

Detail of the Case

Phone of Person making report

Email of Person making report

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COVID Reporting – Medical Practices

Patient DOB

Full Address

Gender

Ethnicity

Race

Name of Person making report

Upload File(s)