COVID-19 POSITIVE TESTING
"Look not every man on his own things, but every man on the things of others." Philippians 2:4
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Your information is confidential and will only be used to assess the positivity rate for precautionary measures. We appreciate your compliance!
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
example@example.com
RTM Church Location
*
Baton Rouge
Beaumont
Dallas
Houston/ Humble
Lafayette
Lake Charles
Monroe
Online member
Have you tested positive for COVID? ***Please notify your local church's medical director of your status. Their contact information is provided below.***
*
Yes
No
Date of Onset (Positive Test Result)
Form of Testing
*
Lab Test (PCR/ Antigen Test)
Self/ At-Home COVID Test
Symptoms
*
No Symptoms
Cough
Fever or chills
Shortness of breath
Fatigue
Headache
Muscle or body aches
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
Other
Have you been at the church or near any saints within 3 days prior to or following testing?
*
Yes
No
Have you notified those of whom you were within Close Contact within that time frame? (If you have not, please contact them immediately to prevent further exposures.)
*
Yes
No
List of close contacts.......
Thank you for notifying us of your status. We will be praying for you! If there are any questions for our medical staff, please feel free to post them below.
https://www.cdc.gov/coronavirus/2019-ncov/your-health/about-covid-19.html
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