Transcription of -19 Extended Form
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-19 Extended Form
Last revised February 2022 Washington State Department of Health Page 1 of 24 DOH 420-107 COVID-19 Infection Signs and Symptoms Estimated 25-40% of cases asymptomatic Usual: fever, cough, short of breath, chills, fatigue, myalgia, headache, sore throat, loss of smell / taste Severe: pneumonia, respiratory failure, stroke, multisystem inflammatory syndrome Incubation The estimated incubation period is 5 days (range 2-14 days) Case classification (for full details see Section 3) Confirmed Not a previous confirmed or probable case in the prior 90 days AND: Detection of SARS-CoV-2 RNA in a clinical or post-mortem specimen using a molecular amplification detection test performed by a CLIA-cert
Organ transplant Immunosuppressive therapy, condition or disease Specify _____ Chronic heart disease Asthma/reactive airway disease Chronic lung disease (e.g., COPD, emphysema) Chronic liver disease Chronic kidney disease Hemoglobinopathy (e.g., sickle cell …
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