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County of Fresno
                                                             DEPARTMENT OF PUBLIC HEALTH

County of Fresno

Department of Public Health


March 1, 2021

This Fresno County Order is issued to ensure access to COVID-19 Diagnostic Testing in outpatient and
ambulatory care settings to effectively prevent, clinically manage, and control COVID-19. This Order is
effective MARCH 1, 2021 and will continue until further notice.

    1. The intent of this Order is to increase access to Diagnostic Testing in the outpatient/ambulatory
       care setting in order to effectively prevent, clinically manage, and control COVID-19 in our
       community. Expansion of Diagnostic Testing is essential because it helps identify individuals who
       are infectious with the virus that causes COVID-19 (SARS-CoV-2), ensure those individuals receive
       appropriate care, protect vulnerable populations, contain spread of COVID-19, better understand
       the spread of the disease in Fresno County and ultimately prevent serious illness and death.
    2. All Healthcare Facilities in the County must provide timely access to Diagnostic Testing to the
       following categories of individuals who seek care or request testing. For acute care hospitals,
       primary care offices, and urgent care clinics, testing or collection of a COVID-19 test sample must
       be available each day the health care facility is open.
       For adults and older children, testing can be offered using self-administered (or collection by a
       caregiver in the case of young children) anterior nasal swabs, but it must be done under medical
       Full details of this procedure are available at the Centers for Disease Control and Prevention
       (CDC) website.
       Health care professionals can observe self-collection of anterior nasal swabs while wearing a
       surgical mask and gloves while standing six feet or more from the patient.
    3. Ambulatory care offices which only provide specialty care services must have the capacity to refer
       patients for COVID-19 testing to a test site that can complete the testing within 24 hours.
    4. Unlike early in the pandemic, laboratory testing capacity has now increased significantly, as has
       the supply of collection material such as swabs. The State of California’s Testing Task Force is
       working with healthcare providers to address any testing supply shortages that arise.

                Promotion, preservation and protection of the community’s health
                            1221 Fulton Street /P. O. Box 11867, Fresno, CA 93775
                                    (559) 600-3200     FAX (559) 600-7687
                      The County of Fresno is an Equal Employment Opportunity Employer
5. Labs which are approved for testing analysis are listed on the California Department of Public
    Health (CDPH) Testing Task Force Website and this list is updated regularly. All medical providers
    are encouraged to work with one or several labs which can provide adequate turnaround time
    and supply support. For more information on local approved laboratories, contact the Fresno
    County Department of Public Health (FCDPH).
6. Testing for COVID-19 should be offered to persons who are symptomatic, or those who are
    asymptomatic if they are working in essential fields where surveillance testing is required, or
    living in residential settings where surveillance testing is required, or identified as close contacts
    of COVID-19 patients as a result of contact tracing or outbreak investigation efforts.
7. For the purposes of this order, only PCR and antigen tests are permitted for diagnostic COVID-19
    testing. Medical Providers are encouraged to become familiar with the operating characteristics
    and limitations of these methods, as listed in the CDPH, CDC websites and the FAQs
    accompanying this order. Antigen testing for patients can be performed instead of PCR testing
    during the first few days of symptomatic illness onset. The exact number of days from symptom
    onset when you can use the rapid antigen test varies based on which of the several rapid antigen
    tests that are available you are using. Due to lower antigen testing sensitivity, if a symptomatic
    patient has a negative rapid antigen test, they should have confirmatory PCR testing. All sites
    required to offer testing on the days they are open are encouraged to offer rapid antigen testing
    for symptomatic patients as described above. Whether or not rapid antigen testing is provided,
    all sites required to offer testing on the days they are open must offer PCR testing to
    accommodate testing of asymptomatic as well as symptomatic patients who have a negative
    rapid antigen test, either through specimen collection for PCR testing that is sent to an
    authorized laboratory for testing, or by offering point of care PCR testing onsite.
8. Where applicable, Healthcare Facilities should seek payment from patients’ group health plans or
    health insurance issuers for any fees, costs, or charges incurred in ordering or completing
    Diagnostic Testing under this Order. The California Department of Health Care Services (DHCS)
    and the California Department of Managed Health Care (DMHC) have both issued guidance
    and/or regulation related to COVID-19 diagnostic testing. Healthcare Facilities shall comply with
    this guidance as well as with all state and/or federal laws prohibiting patients from being billed
    for fees, costs, or charges related to Diagnostic Testing.
9. Healthcare Facilities must publicize information through their typical channels as to how patients
    can access Diagnostic Testing. Healthcare Facilities that have a public or patient-facing website
    must post information on their website about how and when patients can access Diagnostic
    Testing from the Healthcare Facility.
10. Healthcare Facilities and medical providers must continue to comply with the reporting
    requirements regarding COVID-19 or SARS-CoV-2 virus testing results, including reporting of both
    negative and positive results from point-of-care testing, and provision of educational materials to
    patients explaining next steps. Health care facilities and medical providers are also expected to
    provide educational materials developed by FCDPH to patients who are tested for COVID-19 that
    covers what to do while awaiting test results, and next steps if they test positive for COVID-19,
    including isolation of all patients with positive test results and notification of close contacts.
    Elements to be prioritized include:

11. Reporting positive results within one business day or less to patients over text, email, phone or in
        person at the time of the encounter
            a. Report positive cases to Fresno County Department of Public Health using the CalREDIE
                Provider Portal or FCDPH Reporting Form within one business day
            b. Report positive point of care test results using the CalREDIE MLRM or ELR within one
                business days. Please note that positive case reporting (as outlined in 10-b) and the test
                results reporting are separate reporting requirements. For more information on
                reporting go to the Guidance for Medical Providers
            c. Report negative point of care results using the CalREDIE MLRM or ELR within three
                business days

For the purposes of this Order, the following terms are defined as follows:

    1. “COVID-19 Symptom” means new or worsening signs or symptoms consistent with COVID-19,
       including, but not limited to, fever, chills, cough, shortness of breath or difficulty breathing,
       fatigue, muscles or body aches, headache, new loss of smell or taste, sore throat, congestion or
       runny nose, nausea or vomiting, or diarrhea, or as per any updated CDC guidance regarding
       COVID-19 symptoms.
    2. “Diagnostic Testing” means the use of diagnostic tests related to SARS-CoV2, the virus that causes
       COVID-19 or novel coronavirus infection, when the primary purpose of such testing is intended
       for individualized diagnosis or treatment. Only tests with emergency use authorizations (EUA)
       from the U.S. Food and Drug Administration (FDA) should be used for patient care. Currently
       there are two types of diagnostic tests – molecular tests that detect the virus’s genetic material,
       and antigen tests that detect specific proteins on the surface of the virus. See County Public
       Health’s Currently Available SARS-CoV-2 Test Types webpage for more information. Currently
       available SARS-CoV-2 antigen tests must be used in accordance with both the manufacturer’s
       Instructions for Use and the Association of Public Health Laboratory’s (APHL) Considerations for
       Implementation of SARS-CoV-2 Rapid Antigen Testing guidance.
       The APHL document provides information on scenarios where SARS-CoV-2 Antigen tests may be
       considered for use as well as scenarios when they should not be considered. Additional diagnostic
       tests may be authorized in the future.
       The State of California’s COVID-19 Testing Task Force (TTF) may also be able to provide assistance
       to healthcare facilities experiencing shortages and publishes a list of laboratories with testing
       capacity that are willing to receive samples to provide COVID-19 testing on its website at
    3. “Healthcare Facility” means (1) any clinic or urgent care facility located in Fresno County that is
       owned, directly or indirectly, by an entity that also owns or operates an acute care hospital,
       regardless of where that acute care hospital is located or (2) any free-standing clinic (e.g.,
       Federally Qualified Health Center or Rural Health Center, or commercial urgent care clinic.
    4. “Symptomatic Person” means any individual, regardless of age, who has any COVID-19 Symptom.

This Order is issued based on the need for increased testing to detect COVID-19 within the County. Due
to the outbreak of the COVID-19 virus in the general public, which remains a pandemic according to the
World Health Organization, there is a public health emergency throughout Fresno County.

Adequate and widespread availability of Diagnostic Testing are essential to detecting both symptomatic
and asymptomatic transmission of the virus, ensuring persons with COVID-19 receive appropriate care,
identifying cases that need to isolate themselves from others, and informing public health case
investigations and contact tracing efforts, thereby slowing virus transmission as much as possible in order
to protect the most at risk of serious illness from this infection, to prevent further infections and serious
illness and death, and to prevent the healthcare system from being overwhelmed.

Diagnostic Testing is also an essential tool in mitigation efforts in order to understand the prevalence and
spread of the disease in Fresno County.

Existing and widespread community transmission of COVID-19 continues to present a substantial and
significant risk of harm to residents’ health. No vaccines nor failsafe treatments are yet available to
protect against COVID-19. As of October 9, there have been at least 29,000 cases of COVID-19 and 406
deaths reported in Fresno County.

The County shall promptly provide copies of this Order by:
    a. posting it on the FCDPH Website
    b. providing it to any member of the public requesting a copy,
    c. issuing a press release to publicize the Order throughout the County, and
    d. by serving via email to medical providers and ambulatory clinical facilities known to the Health
       Officer that are likely to be subject to this Order (but service via email is not required for

The owner, manager, or operator of any facility that is likely to be impacted by this Order is strongly
encouraged to post a copy of this Order onsite and to provide a copy to any member of the public
requesting a copy.

Because guidance may change, the owner, manager, or operator of any facility that is subject to this
Order is ordered to consult FCDPH daily to identify any modifications to the Order and is required to
comply with any updates until the Order is terminated.

If any subsection, sentence, clause, phrase, or word of this Order or any application of it to any person,
structure, gathering, or circumstance is held to be invalid or unconstitutional by a decision of a court of
competent jurisdiction, then such decision will not affect the validity of the remaining portions or
applications of this Order.

This Order shall become effective at 12:01 am on March 1, 2021 and will continue to be until it is revised,
rescinded, superseded, or amended in writing by the Health Officer.


I, as Interim Health Officer for the County of Fresno, encourage voluntary compliance with this Health
Officer’s Order. However, violation of this order is subject to fine, imprisonments or both (California Health
and Safety Code Section 120295.)

Violation of or failure to comply with this Order is punishable by fine, imprisonment or both under various
criminal statutes:

Cal. Penal Code section 148 makes it a misdemeanor to resist, delay, or obstruct a public officer, in the
discharge of his or her duty. Sheriff deputies and city police officers are authorized to enforce health orders
in the discharge of his or her duty.

Cal. Penal Code section 69 may be charged as a felony for the attempt, by means of any threat or violence,
to deter or prevent an executive officer from performing any duty imposed by law, or to knowingly resist,
by the use of force or violence, the officer, in the performance of the officer's duty. Sheriff deputies and
city police officers are authorized to enforce health orders in the discharge of his or her duty.

Cal. Penal Code section 409.5 allows the health officer to close an area where a calamity has created an
immediate menace to public health.

California Health and Safety Code sections 120275 and 120295 makes it a misdemeanor to violate certain
sections of the Health and Safety Code, including those requiring individuals to comply with health orders
to facilitate isolation or quarantine.

________________________________________                            _3/1/2021______________
Rais Vohra, MD                                                      Date
Health Officer

COVID-19 Testing Health Officer Order FAQ’s
                                  3/1/2021 Update

1. Testing Methods and Labs Overview
     a. Which test methods will comply with this order?
         Any PCR test whether it be collected with nasopharyngeal, anterior nasal or saliva
         samples complies with the order. U.S. Food and Drug Administration (FDA) approved
         antigen tests comply with this order too. Point of Care PCR testing and Antigen testing
         also complies with this order.
     b. Does Antibody testing comply with this order?
         No. Antibody testing does not comply with this order.
     c. Which labs can I reach out to support testing my patient?
         The Fresno County Department of Public Health (FCDPH) has chosen 5 labs from the CA
         Testing Taskforce list (see below) that are willing to work with providers and offices in
         Fresno County to provide COVID-19 testing.
         For a complete list of approved labs in the state of California go to the CA Testing
         Taskforce site at
         07_2_20.pdf. This site is regularly updated to provide the most up to date list of labs
         that can perform COVID-19 tests.

                      Lab/ Company                                      Contact Person

       CONSOLIDATED MEDICAL                   (Michelle Fan)

       (714) 657-7369; (714) 717-5565                  (714) 345-9827
       Toll Free: (800) 4-CMB-LAB

       FULGENT GENETICS                                Rachel Blake
       (626) 350-0537                        

       MIRA DX, INC                                    Kyle Dodenhoff
       (424) 387-8100
                                                       (203) 671-1308

      Department of Public Health                                                        Page 1 of 8                                                                  MR 3/1/2021
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     COLOR GENOMICS INC                              Amy Lockwood
     (844) 352-6567                        

     Valley Diagnostics Lab Inc.                     Osama Qarni             

                                                     (559) 363-8909

d. Will these labs provide supplies, courier services etc.?
       Yes. Each lab provides swabs and transport medium. PPE is not provided. Courier
       services are provided by some labs. Please see the lab spreadsheet for more
       information on this.
e. Will these labs bill insurance providers to cover the cost of testing?
       This will depend on the lab you are contracted with. You will need to ask each lab you
       work with.
f. What if my patient is not insured but symptomatic?
       The CARES Act covers testing for all symptomatic patients.
g. What if my patient is not insured but asymptomatic?
       Some patients are covered if they are a close contact or an essential worker, others may
       not be covered.
h. What if my patient is working at a school/workplace that has an outbreak, and
   wants to be tested?
       They should be tested and will likely be covered by their insurance.
i. Why are specialty offices not required to offer COVID-19 testing?
       Specialty offices are generally seeing patients for scheduled visits, not for acute
       symptoms. For that reason, most of the tests they order including pre-operative orders
       are not as time sensitive. If a patient is seen in a specialty office and does have
       symptoms of COVID-19, the specialty office is expected to send the patient to a site that
       can complete COVID-19 testing within 24 hours.
j.     Can I send my patients to other sites within my network to satisfy this
       No. Each office required to provide COVID-19 testing with this Health Officer Order must
       have the capability to provide COVID-19 testing on a daily basis. This will increase access
       and reduce barriers to COVID-19 testing that is needed to control this pandemic. This

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                                  3/1/2021 Update

         Health Officer Order does allow you to refer patients for testing if the patient is unable
         to perform a self-swab (see 3e below) For patients who lack primary care, the FCDPH
         has a list of testing facilities in Fresno County:

2. Registration of Patients: How to Do this Accurately and Quickly
      a. What is the best way to pre-register patients?
         You can place patients on your schedule in your EMR like you would if they came in for a
         regular appointment. Providers can place an order for the COVID-19 test and all
         information that needs to be sent with the test printed out ahead of time and placed in
         a biohazard bag with their swab. Some offices do a telehealth visit prior to screen
         patients to see what swabs they may need and if a COVID-19 test is needed. At that
         time an order is placed for each test (COVID-19, flu, strep, etc.). The patient may then be
         given a drive through time to show up for in their cars when a provider is there to
         collect all the swabs at one time.
      b. What is needed to register patients onsite?
         You would need their name, date of birth and contact information. If they are a
         preexisting patient, then they should be in your system already. If they are a new
         patient, you would need their insurance information to bill for the testing. There might
         be additional information that is specific to what your office requires which you would
         need to get at the time of the test.
      c. Can I offer drive up or drive through testing to comply with this order?
         Yes. This is encouraged to limit PPE use and exposure to other staff or patients in the
      d. What is my responsibility as a health care provider when I see a patient for a
         COVID-19 test?
         Just like any other patient encounter, get a good history focusing on COVID-19
         symptoms, potential viral exposures, significant comorbidities, and alternative
         diagnoses. If the visit is in-person, perform a targeted examination. Your assessment
         should indicate if COVID-19 testing is indicated. Your plan should include ordering the
         COVID-19 test, counseling the patient regarding the test itself (see 2e below), warning
         signs and further follow-up, and any resultant isolation, quarantine, or contact tracing,
         You must also be prepared to report COVID-19 testing results to the patient and to
         FCDPH (see 3i below).
      e. Am I required to obtain a COVID-19 test if a patient has COVID-19 symptoms?
         Yes. Determining if a symptomatic patient does or does not have COVID-19 has major
         implications for limiting the spread of COVID-19 in our community, as well as for the
         patient who would otherwise need to Isolate for 10 days if they test positive for COVID-
         19, and for close contacts who would otherwise need to Quarantine for 10 days after
         their last close contact with a COVID-19 positive case unless they have completed their
         COVID-19 vaccinations within the last 3 months and it is at least 14 days since their final

      Department of Public Health                                                        Page 3 of 8                                                                    MR 3/1/2021
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   vaccination. This health officer order allows for symptomatic individuals to return to
   their regular activities if they test negative and are no longer symptomatic and includes
   communication with close contacts only after a patient tests positive. Symptoms of
            i.  Fever or chills
           ii.  Cough
          iii.  Shortness of breath or difficulty breathing
          iv.   Fatigue
           v.   Congestion or runny nose
          vi.   Repeated shaking/ tremors
         vii.   Muscle pains or body aches
        viii.   Headache
          ix.   Sore throat
           x.   New loss of taste or smell
          xi.   Nausea, vomiting or diarrhea
f. Do I need to do a COVID-19 test if a patient has an alternative, laboratory
   confirmed diagnosis, such as a positive strep result for sore throat, or a positive
   influenza result for cough?
   No. If you as a licensed health care provider determine that your patients symptoms are
   not new or worsening based on a chronic medical condition that is documented in your
   medical record, or if you have a laboratory confirmed diagnosis that is consistent with
   an alternative diagnosis other than COVID-19 such as a positive strep test for someone
   with sore throat or a positive influenza screen for someone with respiratory symptoms,
   you do not need to also do a COVID-19 test.
g. What patient education and counseling should I provide?
   The FCDPH has developed educational materials that you can use for patients who have
   been tested, are symptomatic, have a positive COVID-19 test, or who are close contacts
   of someone who has tested positive.
   For more information for providers visit:
   For more information for patients on Isolation, Quarantine, and What To Do While
   Waiting for Test Results visit and refer your patients to:
h. Can I bill for COVID-19 testing and counseling?
   Yes. The American Medical Association (AMA) put out specific guidelines for billing for
   COVID-19 counseling. You can also build smart phrases in your EMR to make it easier to
   document what is needed to bill for counseling.
   The Centers for Medicare and Medicaid Services (CMS) also put out a counseling
   checklist for COVID-19 counseling.

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3. Doing the Test: Best Practice Tips
      a. What is the difference between nasal and nasopharyngeal swabbing?
         We encourage providers to do anterior nasal self-swabs when possible to limit PPE.
         Nasopharyngeal swabs have to be done by trained medical personnel. Nasal swabs can
         be done by the patient with direct observation from medical personnel. See below links
         for instructions on both.
               Nasal swabs:
               Nasopharyngeal swabs:
         Quest Lab requires a specific swab for each type of test anterior nasal versus
         nasopharyngeal. LabCorp both anterior nasal and nasopharyngeal specimens can be
         done on the same swab.
      b. Can we do saliva or oral testing?
         Yes, but these tests are not currently available in our area. Check with the lab you are
         contracted with to see what types of tests they have available.
      c. What Personal Protective Equipment (PPE) is needed for swabbing a patient?
         Anterior nasal swabs and saliva testing require the following PPE, a cloth or surgical
         mask and eye covering to observe self-swab as test is self-administered by the patient
         with direct observation of a medical personnel. Nasopharyngeal swabs require PPE with
         N95 mask, face shield or goggles, gloves and gown.
      d. What PPE is needed when the patient does a self-swab?
         A cloth or surgical mask and eye covering for medical personnel is required for self-
      e. Nasopharyngeal and oropharyngeal swabbing require extensive use of PPE.
         Does this order require my office to do nasopharyngeal or oropharyngeal
         swabbing on a daily basis?
         No. You are expected to be able to provide self-swabbing with anterior nasal swabs on a
         daily basis, but you are not required to perform nasopharyngeal or oropharyngeal
         swabbing. You are expected to have an alternative site where you can send patients on
         the day of service if they are unable to perform an anterior nasal self-swab. You are also
         expected to have appropriate PPE available at all times to manage patients with COVID-
         19 symptoms who are seen in the office setting.
      f. How do we swab small children who cannot swab themselves?
         Small children can be self-swabbed by a parent/guardian or healthcare professional
         using the anterior nasal technique or can be swabbed by a healthcare professional using
         the nasopharyngeal technique.

      Department of Public Health                                                       Page 5 of 8                                                                  MR 3/1/2021
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      g. What should I tell patients before they swab themselves?
         Be careful, go as slow as needed, and make surface contact (touching the sides is more
         important than going very deep).
      h. What if a patient drops or misplaces the swab?
         You will need to give them a new swab to repeat the test.
      i. Do I need to report COVID-19 test results?
         Yes, you as a health care provider have a responsibility to report positive COVID-19 test
         results. Your office also has a responsibility to report both positive and negative Point of
         Care (POC) test results. For further information, go to:
      j. Do I have to report negative POC tests?
         Yes. Negative POC tests are required to be reported through the ELR or CalREDIE
         Manual Lab Reporting Module (MLRM); they should NOT be reported using the lab
         reporting tab of the Provider Portal (Labs reported in the provider portal but not the lab
         portals do not get counted correctly). More information on this can be found at

4. Contact Tracing Best Practices and Resources
      a. What is contact tracing? Why is it important?
         Contact tracing is a disease control strategy that involves identifying people who have
         an infectious disease (cases) and their close contacts (people who may have been
         exposed, and places they’ve been) and working with them to interrupt disease
         transmission. Contact tracing should start on the day the patient gets swabbed. It is
         important to obtain this information as early as possible to get as accurate information
         as possible. Offices can sign up to report directly to CalREDIE using the provider portal.
         A staff person can be assigned to enter the reporting and contact tracing information.
         Contact tracing training through the state is free and can be accessed through this link:
         Time is of the essence. Identifying contacts and ensuring they do not interact with
         others is critical to protect communities from further spread. Clinicians can help by
         asking their patients to begin identifying people they have been in contact 48 hours
         prior to the onset of symptoms and until the patient has isolated or starting from time
         of test date if they are asymptomatic. If communities are unable to effectively isolate
         patients and ensure contacts can separate themselves from others, rapid community
         spread of COVID-19 is likely to increase to the point that strict mitigation strategies will
         again be needed to contain the virus. The success of contact tracing depends in large
         part on a community’s acceptance and participation. For many community members,
         interacting with a case investigator or a contact tracer for COVID-19 may be the first
         time they engage with public health personnel.

      Department of Public Health                                                         Page 6 of 8                                                                     MR 3/1/2021
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b. What information is absolutely necessary to capture for contact tracing?
    Offices can sign up to report directly to CalREDIE using the Provider Portal. A staff
    person can be assigned to enter the reporting and contact tracing information. In the
    Provider Portal, contacts to the patient can be reported under the Supplemental Tab in
    the Notes/Remarks section. Please place a semicolon at the end of each contact’s
    information and start a new line per contact.
         Example:
             Name1, phone number, household contact, email, contact under 18years old;
             Name2, phone number, address, email;
    Please also include information on if the patient lives in a congregated setting or is
    known to have attended a gathering in this Notes/Remarks section.
c. Can I bill for contact tracing?
    Yes. For a complete review please see the CMS link:
d. Can my clinic staff capture this information and I review it prior to submission?
e. What information should a patient be told at the time of discharge?
         Patients should not return to work or school while symptomatic and waiting for
            test results
         If the patient is symptomatic, self-isolate for 10 days, with symptoms improving
            and fever free for 24 hours without the use of fever reducing medications
            and/or until a negative result is received
         If the patient is positive for COVID-19 regardless of symptoms - isolate for 10
            days, with symptoms improving and fever free for 24 hours without the use of
            fever reducing medications
         Close Contacts to a person positive with COVID-19 must quarantine for 14 days
            from last possible close contact to the COVID-19 positive patient regardless of
            your patients’ negative result
   Below are great patient handouts you can give:
         3 Key Steps to Take While Waiting for Your COVID-19 Test Result
         How Does Contact Tracing Work?
f. What if my patient is an Essential Worker?
   If your patient is an essential worker as defined by the State of California they are not
   required to quarantine as defined the Health Officer Order and may return to work if
   they remain symptom free with masking and on-going monitoring of symptoms

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     g. What information should I relay to patients who test positive?
         They need to isolate in their home from all contacts inside and outside their home for
         10 days from symptoms onset, or test date if they never had symptoms, and until
         symptom improvement and fever free for 24 hours without the use of fever reducing
         medications. If they cannot isolate from contacts in their home, they need to wear a
         mask at all times, even within their home. See the patient handout from the Centers for
         Disease Control and Prevention (CDC) on guidance:
     h. How do I know if someone is a close contact?
         A close contact is defined as someone who has been within 6 feet of an infected
         person(s) for a total of 15 minutes or more over a 24-hour period, cumulative time,
         during the infectious period.
     i. What is cumulative time?
         For the purposes of determining a close contact, cumulative time is defined as the
         period of time of exposure to ANY/ALL COVID-19 positive person(s), and is calculated as
         15 minutes or more of time where a close contact has been in contact to a person(s)
         positive with COVID-19 while that person(s) was infectious – i.e. – 2 days prior to
         symptom onset while symptomatic, or 2 days prior to test date if asymptomatic, up to
         the last contact with the COVID-19 positive person(s).
     j. What if my patients need support to remain in isolation or quarantine?
         The Housing for the Harvest program supports patients who are farm and food
         processing employees who may need help with housing while they isolate/quarantine.
         For more information, go to:

5. COVID-19 and Influenza: Considerations for the Winter Months
     a. How does influenza differ from COVID-19 or other wintertime viral illnesses?
         The CDC has a great comparison at this link:
     b. How does COVID-19 differ from allergies/smoke inhalation from the fires?
         The CDC has a great comparison at this link:
     c. In which groups will an influenza vaccine be required this year?
         All healthcare providers will be required to get an influenza vaccine this year. Everyone
         6 months of age and older are recommended to get the influenza vaccine.

      Department of Public Health                                                      Page 8 of 8                                                                  MR 3/1/2021
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