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Department Of Health __________ County Health DepartmentQUARANTINE TO FACILITY ORDER
By authority of Chapters 381 and 252, Florida Statutesand Chapter 64D-3, Florida Administrative Code _____ CHD Order #____________.You, __________(name)_____________, have been identified as a person classified as a _______________ “contact,” or identified as a confirmed case, a probable case, or suspectcase of ______________________________, a communicable disease or unsafe condition thatposes a threat to the public health YOU ARE NOT PERMITTED TO LEAVE _________________________________.You are QUARANTINED to your __________________________, and shall remain there fromthe date of this Order until (date) , or until released from quarantine by the undersigned, suchrecommendation to be made by the State Epidemiologist or State Health Officer.While in QUARANTINE, you shall comply with the orders of the facility medical personnelregarding your medical care. You shall cooperate with the County Health Department (CHD)and with CHD access to you and to your medical records for purposes of delivering ormonitoring your medical care.Other Requirements/Orders:1
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