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Department Of Health __________ County Health DepartmentQUARANTINE OF FACILITY ORDER(Hospital/Medical/Security/Parts Thereof)
By authority of Chapters 381 and 252, Florida Statutesand Chapter 64D-3, Florida Administrative Code _____ CHD Order #____________.Due to an outbreak and/or the high volume of ______________ cases which is a communicabledisease or unsafe condition, you, _____________(name)_______________, as theadministrator, authorized representative, or person in charge of the ________________________ facility are hereby notified by the _______ County HealthDepartment (CHD) that ___________________ of your facility is placed under a QUARANTINE.This order is in force from the date below until (date) or until QUARANTINE is released by theundersigned authority. No person shall be allowed to enter or leave your facility without thewritten approval of the undersigned.While this QUARANTINE is in effect, you shall comply with all orders of the _______ CountyHealth Department.Other Requirements/Orders:Reasons For Above:1
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