HHS Covid Notification

Please fill out the form below if your student has tested positive.

Student Name Student Name First Last
Student Number
Date of Birth Date of Birth / MM / DD YYYY
Name of person completing this form Name of person completing this form First Last
Contact # for person completing this form Contact # for person completing this form - ### - ### ####
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Select an option below

Select an option below writen lab confirmation of positive results home positive result
Upload results here (photo or file)

Attach Files
Parent/Guardian Name Parent/Guardian Name First Last
Phone Phone - ### - ### ####
Parent Email
Names of school age siblings and/or parent/guardian that work in Pasco County Schools including location (i.e Jane Smith-Hudson High School)
Date of onset of symptoms if known Date of onset of symptoms if known / MM / DD YYYY
Date test administered Date test administered / MM / DD YYYY
Last date in attendance Last date in attendance / MM / DD YYYY
Notes
Extracurricular Activities (Sports, band, etc...)