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Certificate of recovery


Sari

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  • 2 weeks later...

In general it can look like this, but every physician practice may use their own paperwork/form:

NAME OF PRACTICE

Street Address

Phone: xxxxx Fax: xxxxxxxx

 CLIA ID Number: xxxxxxxx, Expires xxxxxxxx

COVID-19 CERTIFICATE OF RECOVERY

 Today’s date:             x/x/2022

Patient Name:            xxxxxxxxx

Patient DOB:              mm/dd/yyyy

Patient Address:       xxxxxxxxxxxxxx

 

The patient’s test results have been reviewed and confirmed as the following:

Location:                  xxxxx

CLIA ID Number:      xxxxx

Test Type:                NAAT/PCR

Test Date:                xx/xx/2022

Test Result:             POSITIVE

 

The patient has confirmed:

·         They’ve had no symptoms of COVID-19 (no fever, nausea, headaches, vomiting or respiratory problems) within the last 72 hours

·         They’ve completed their isolation period

·         At least 7 days have elapsed since the date of their positive test

·         They have fully recovered from COVID-19

·         They have no current medical condition that would preclude them from work and/or travel

 

Given the above, it’s concluded that the patient:

·         Has fully recovered from COVID-19 and is not considered infectious

·         Appears fit to return to work and/or travel

 

Important considerations for the patient and receiving authority:

·         The patient must follow local COVID-19 guidelines if symptoms develop, including any mandatory isolation prior to work and/or travel

·         This COVID-19 certificate of recovery should be presented alongside the patient’s positive test result certificate to confirm the test details

 

Signed by:

 

Dr. XXXXXXX XXXXXXXXX                  Date:

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