Thank you for taking the time to complete this form. It is important for us to gather this information to understand the current outbreak and to prevent further illness. Please complete this form for all positive COVID-19 cases, new hospitalizations, and/or deaths. For hospitalizations: only report those admitted as a result of COVID-19 illness, including individuals tested in other healthcare settings.
Additional information not on this form can be entered into the bottom section Notes
For more information or questions about reporting, please contact CaseCoordinationManagement@dhhs.nh.gov, 603-271-4496, or visit: https://www.covid19.nh.gov/resources/general-provider-covid-19-resources-and-information.