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Department Of Health
__________ County Health Department
QUARANTINE OF FACILITY ORDER
(Hospital/Medical/Security/Parts Thereof)
By authority of Chapters 381 and 252, Florida Statutes
and Chapter 64D-3, Florida Administrative Code
_____ CHD Order #____________.

Due to an outbreak and/or the high volume of______________ cases which is a communicable
disease or unsafe condition, you,_____________(name)_______________, as the
administrator, authorized representative, or person in charge of the

________________________ facility are hereby notified by the _______ County Health
Department (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 the
undersigned authority. No person shall be allowed to enter or leave your facility without the
written approval of the undersigned.

While this QUARANTINE is in effect, you shall comply with all orders of the_______ County
Health Department.
Other Requirements/Orders:
Reasons For Above:
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