NOTE: Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested.
COVID-19 Case Report Form
- New loss of taste or smell
- Nausea or vomiting
- Sore throat
- Rhinorrhea or congestion
- Has the patient had close contact with a person with laboratory confirmed COVID-19 infection?
- Has the person traveled outside of Hawaii?
- Hospitalized patients
- Healthcare workers, workers in congregate living settings, first responders with symptoms
- Residents in long-term care facilities or other congregate settings, including prisons and shelters, with symptoms
- Persons identified through public health cluster and selected contact investigations
- Persons with symptoms of potential COVID-19 infection, including fever, cough, shortness of breath, chills, muscle pain, new loss of taste or smell, vomiting or diarrhea and/or sore throat
- Other groups or persons prioritized for testing as part of public health investigation or surveillance activities
PLEASE NOTE: Per the Hawaii Administrative Rules, Chapter 11-156, the Case Report Form must be completed for any person who tests POSITIVE for COVID-19. Please fax the completed form to the Disease Outbreak Control Division at (808) 586-4595. COVID-19 is considered an URGENTLY REPORTABLE condition.
- Residents or employees of congregate settings that serve vulnerable populations (e.g., long-term care facilities, assisted living facilities, residential care homes, homeless shelters, residential treatment facilities)
- Persons involved in front-line COVID-19 response efforts (e.g., emergency medical services, law enforcement, firefighters, public safety workers)
- Close contacts of a confirmed case (Note: Not all close contacts of confirmed cases require testing if results will not alter clinical or public health actions)
- Persons identified through COVID-19 cluster investigations
- Persons with suspect COVID-19 identified through airport screening
- Hospitalized patients with suspect COVID-19, if clinical laboratory testing is not readily available.