Monroe County Isolation and Quarantine Plan

Department of Public Health
Monroe County, New York
Adam J. Bello Michael D. Mendoza, MD, MPH, MS, FAAFP

County Executive Commissioner of Public Health
ISOLATION AND QUARANTINE

PLAN
An Annex to the
PUBLIC HEALTH EMERGENCY
PREPAREDNESS AND RESPONSE PLAN
APPROVED, 10/21/2014
UPDATED, 2/1/2020
111 Westfall Road • Rochester, New York 14620

Phone: (585) 753-2991 • fax: (585) 753-5115
www.monroecounty.gov
Page Intentionally Left Blank
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MCDPH Isolation and Quarantine
Rev. 11 (02/01/2020)
Signature Page
Signature: ________//Original Signed//______________ Date: __2/01/2020_________

Michael D. Mendoza, MD, MPH, MS, FAAFP
Commissioner of Public Health
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REVIEW AND REVISION RECORD
Individual
Change
Section Date of Change Making Description of Change
Number
Changes
1 All 10/14/2014 Sayers/S. Sharp Updated – Rev. 2
2 All 10/21/2014 L. Kozelsky Page numbers updated
3 Chapter 4 10/21/2014 Sayers MCSO/LE Roles
Term “Director’s Order”

4 All 10/21/2014 L. Kozelsky
changed to “Health Order”
5 Appendix A 1/29/2015 L. Kozelsky Housekeeping
Updated appropriate
forms/letterhead to reflect
Appendix A, K 6/8/2015 L. Kozelsky
6 Dr. Cushman as Interim
Health Commissioner
Appendix A1 – Housekeeping- new

7 02/04/2016 S. Sharp
A4 County Executive
Appendix A1 –
8 04/25/2016 S. Sharp Housekeeping
A4
Updated appropriate
Cover page and forms/letterhead to reflect
9 01/27/2017 L. Phonharath
signature page Dr. Mendoza as Health
Commissioner
General information
All areas of
updating to include
base document
10 3/22/19 M. Sayers grammatical corrections,
and appendices
new information and
B, I, J, K-5, L, N
updated contacts.
Cover, Updated cover ,signature
11 signature page, 2/01/20 M.Sayers pages, App B, completed
Chp 7, App B para 7.8
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TABLE OF CONTENTS
CHAPTER 1: INTRODUCTION ............................................................................................................ 1

1.1 Purpose............................................................................................................................................. 1
1.2 Scope ................................................................................................................................................ 1
1.3 Definitions ........................................................................................................................................ 2
1.4 Authority........................................................................................................................................... 3
1.5 Policy ................................................................................................................................................ 3
CHAPTER 2: PLANNING ASSUMPTIONS ............................................................................................ 5

2.1 Planning Assumptions ...................................................................................................................... 5
CHAPTER 3: ROLES AND RESPONSIBILITIES....................................................................................... 6

3.1 Monroe County Department of Public Health ................................................................................. 6
3.2 Monroe County Attorney ................................................................................................................. 6
3.3 Monroe County Sheriff’s Office (MCSO) .......................................................................................... 7
3.4 Other Law Enforcement Agencies .................................................................................................... 7
3.5 Monroe County Office of Probation and Corrections Office ........................................................... 7
3.6 Monroe County Supreme Court ....................................................................................................... 7
3.7 Appellate Division Court ................................................................................................................... 7
3.8 Emergency Medical Services ............................................................................................................ 7
3.9 Monroe County Hospitals................................................................................................................. 7
3.10 Monroe County Physicians ............................................................................................................. 7
3.11 Monroe County Office of Emergency Management ...................................................................... 8
CHAPTER 4: CONCEPT OF OPERATIONS ............................................................................................ 9

4.1 Activation ......................................................................................................................................... 9
4.2 Direction and Control ....................................................................................................................... 9
4.3 Health Order vs. Court Order ......................................................................................................... 10
4.4 Requesting State of Emergency ..................................................................................................... 10
CHAPTER 5: PROTOCOL FOR VOLUNTARY ISOLATION AND QUARANTINE ....................................... 11

5.1 Legal Documents Utilized for Voluntary Isolation and Quarantine ............................................... 11
5.2 Determination of Need for Voluntary Isolation or Quarantine ..................................................... 11
5.3 Notification for Voluntary Isolation or Quarantine........................................................................ 11
5.4 Contents of the Agreement Letter Requesting Voluntary Isolation or Quarantine ...................... 11
5.5 Method of Isolation or Quarantine ................................................................................................ 12
5.6 Transportation of Patients ............................................................................................................. 12
5.7 Protection of Health Workers and Household Members .............................................................. 12
5.8 Personal Needs of Patients ............................................................................................................ 12
5.9 Compliance Monitoring Plan .......................................................................................................... 13
5.10 Non-compliance with a Request for Voluntary Isolation or Quarantine ..................................... 13
5.11 Documentation............................................................................................................................. 13
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CHAPTER 6: PROTOCOL FOR INVOLUNTARY ISOLATION OR QUARANTINE – HEALTH ORDER........... 15
6.1 Legal Documents Utilized for Involuntary Isolation or Quarantine – Health Order ...................... 15
6.2 Determination of Need for Involuntary Isolation or Quarantine................................................... 15
6.3 Issuing a Health Order for Involuntary Isolation or for Quarantine .............................................. 15
6.4 Serving a Health Order for Isolation or Quarantine ....................................................................... 16
6.5 Hearing ........................................................................................................................................... 16
6.6 Method of Involuntary Isolation or Quarantine ............................................................................ 17
6.7 Transportation of Patients ............................................................................................................. 17
6.8 Protection of Health Care Workers and Household Members ...................................................... 18
6.9 Compliance Monitoring Plan .......................................................................................................... 18
6.10 Enforcement of Order .................................................................................................................. 18
6.11 Non-Compliance with a Health Order .......................................................................................... 19
6.12 Documentation............................................................................................................................. 19
CHAPTER 7: PROTOCOL FOR INVOLUNTARY ISOLATION OR QUARANTINE BY COURT ORDER .......... 21

7.1 Obtaining a Court Order for Involuntary Isolation or Quarantine ................................................. 21
7.2 Petition/Order to Show Cause for Isolation or Quarantine ........................................................... 21
7.3 Affidavit of the Commissioner........................................................................................................ 21
7.4 Procedure for Filing the Petition/Order ......................................................................................... 21
7.5 Serving the Order to Show Cause Petition and Supporting Papers on an Individual or Responsible
Party ..................................................................................................................................................... 22
7.6 Hearing ........................................................................................................................................... 22
7.7 Court Order for Isolation or Quarantine ........................................................................................ 22
7.8 Serving the Court Order for Isolation or Quarantine ..................................................................... 23
7.9 Continuation of Court Order for Isolation or Quarantine .............................................................. 23
7.10 Consolidation of Claims into Groups ............................................................................................ 23
7.11 Method of Involuntary Isolation or Quarantine .......................................................................... 23
7.12 Transportation of Patients ........................................................................................................... 24
7.13 Protection of Health Workers and Household Members ............................................................ 24
7.14 Compliance Monitoring Plan ........................................................................................................ 24
7.15 Enforcement Plan ......................................................................................................................... 25
7.16 Non-compliance with a Court Order ............................................................................................ 25
7.17 Documentation............................................................................................................................. 26
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APPENDICES
A. Legal Documents
B. Contact Information for Key Personnel
C. Alternate Sites to Hold Hearings
D. Alternate Isolation and Quarantine Sites
E. Monroe County Department of Public Health Isolation and Quarantine Record
F. Home or Facility Isolation/Quarantine Assessment Checklist
G. Health Department Daily Monitoring Log
H. Log of Obstacles to Compliance and Resource Referrals
I. Monroe County Support Services Listing
J. Environmental Decontamination Agencies
K. Patient Information Packet
L. List of Communicable Diseases/Quarantinable Diseases
M. MCDPH Tuberculosis Control Program – Delinquent Cases/Suspect Procedures
N. Acronyms
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CHAPTER 1: INTRODUCTION
Isolation and Quarantine (I & Q) are public health control measures designed to protect the public by
limiting contact between persons who are, or may be, contagious and others who are susceptible to
infection. The Isolation and Quarantine Plan provides guidance and structure to Monroe County
Department of Public Health (MCDPH) and partners regarding initiation, continuance and release from
I & Q. This plan is coordinated with other MCDPH preparedness plans and activities and will be
coordinated with the plans of community, state and federal partners.
1.1 PURPOSE
The purpose of this document is to define the policies and procedures for the utilization of Isolation
and Quarantine as a tool for communicable disease control in Monroe County of diagnosed and
suspected cases and contacts of cases of communicable diseases listed in 10 NYCRR 2.1. The plan
describes the circumstances, authority and events that may necessitate specific leadership decisions,
response actions and communications mechanisms. The purpose of this plan is to:
• Guide the decision-making criteria to be used by the MCDPH Commissioner of Public Health or
designee when isolation and/or quarantine are beyond the scope of current communicable
disease practices.
• Identify the authorities of MCDPH and partner agencies in the event of a disease outbreak
requiring I & Q of one or more individuals.
• Describe specific procedures for supporting home-based I & Q of small and large numbers of
individuals.
• Describe procedures for staffing and provisioning a dedicated facility for I & Q of persons who
cannot stay at their homes or do not have a suitable home environment.
• Define roles and responsibilities for MCDPH, local health care partners, and local response
agencies during an outbreak event requiring I & Q.
• Describe how communication and coordination will occur between MCDPH, local and state
entities during such an event.
• Assist MCDPH and response partners with limiting the spread of infectious diseases, illness and
death.
• Provide direction for communication with the isolated and quarantined individuals, the public
in general and the media.
1.2 SCOPE
This plan is an Annex to the MCDPH Public Health Emergency Preparedness and Response Plan
(PHEPR). This plan primarily focuses on the roles, responsibilities, and activities of MCDPH, however,
specific responsibilities for key partners are included to highlight points of coordination between
agencies during situations involving I & Q.
This plan applies to:

• Infectious diseases including, but not limited to, plague, smallpox, measles, yellow fever, viral
hemorrhagic fevers such as Ebola and Severe Acute Respiratory Syndrome (SARS), that are
beyond the capacities of current communicable disease practices utilized by the
Epidemiology/Disease Control Unit. Epidemiology/Disease Control Unit standard policy and
procedures include routine isolation and quarantine measures for diseases including, but not
limited to mumps and/or whooping cough. For Tuberculosis related I & Q, see Appendix M.
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• MCDPH and partner agencies with whom there are established contracts, memoranda of
agreement or procedures for disease outbreak events.
• Persons in Monroe County either infected with, exposed, or potentially exposed to the
infectious agent in question.
1.3 DEFINITIONS
1.3.1 Communicable Disease (CD) refers to those diseases identified in 2.1 of the New York State
Sanitary Code (10 NYCRR 2.1).
1.3.2 "Isolation shall consist of the separation from other persons, in such places, under such
circumstances, and for such time, as will prevent transmission of the infectious agent, of persons
known to be ill or suspected of being infected." (10 NYCRR 2.25(d)).
1.3.3 “Personal quarantine shall mean restricting household contacts and/or incidental contacts to
premises designated by the health officer." (10 NYCRR 2.25(f))
1.3.4 "Quarantine of premises, except as specifically modified in other sections of this Chapter, shall
consist of:
• Prohibition of entrance into or exit from the premises, as designated by the health officer,
where a case of communicable disease exists of any person other than medical attendants and
such others as may be authorized by the health officer; and
• Prohibition, without permission and instructions from the health officer, of the removal from
such premises of any article liable to contamination with infective material through contact
with the patient or with his secretions or excretions, unless such article has been disinfected."
(10 NYCRR 2.25(e))
1.3.5 Least Restrictive Measures shall be defined as measures recommended by the Center for Disease
Control (CDC) that protects the general public while causing the least restrictions of the patient’s
activities of daily living and minimizing potential hardship for the individual and his/her family. This
may be achieved by discussing the various CDC alternatives with the individual, if possible, or his/her
representatives to provide opportunity for a choice of an effective method of isolation/quarantine.
1.3.6 “Case is defined as a person who has been diagnosed to have a particular disease or condition.
The diagnosis may be based solely on clinical judgment or solely on laboratory evidence, or both
criteria.” (10 NYCRR 2.2(b))
1.3.7 “Suspected case is defined as a person who has been diagnosed to be likely to have a particular
disease or condition. The suspected diagnosis may be based solely on clinical judgment or solely on
laboratory evidence or both criteria”. (10 NYCRR 2.2(c))
1.3.8 “Outbreak is defined as an increased incidence of disease above its expected or baseline level...
While an outbreak usually involves several cases of illness (e.g., food-borne poisoning, influenza), it
may consist of just one case for certain rare and/or serious diseases (e.g., botulism, measles).” (10
NYCRR 2.2(d))
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1.4 AUTHORITY
The MCDPH Commissioner of Public Health’s authority for Isolation and Quarantine is provided in
Article 21 (Control of Acute Communicable Diseases) of the New York Public Health Law (NY PHL Article
21) and 10 NYCRR Part 2.
1.5 POLICY
Monroe County will:
• Utilize isolation or quarantine when the MCDPH Commissioner of Public Health or designee
determines that use of these measures are:
 Necessary and appropriate to prevent the spread of a communicable disease listed in 10
NYCRR 2.1.
 Found to be consistent with the recommendations of national public health authorities
after a review has been done.
 When all other measures have been exhausted.
• Inform individuals of their due process with the goal to utilize the least restrictive methods in
ordering isolation or quarantine.
• Utilize voluntary isolation or quarantine before resorting to involuntary isolation or quarantine
whenever possible.
• Utilize voluntary isolation or quarantine when the MCDPH Commissioner of Public Health or
designee determines that the risk of non-compliance is minimal.
• Utilize involuntary isolation or quarantine when the MCDPH Commissioner of Public Health or
designee determines that the risk of non-compliance is present or when non-compliance with
voluntary isolation or quarantine has occurred.
• Utilize a Health Order to authorize involuntary isolation or quarantine when the MCDPH
Commissioner of Public Health or designee has determined that a delay implementing such a
Court Order may result in an immediate and serious threat to public health.
• Obtain a Court Order to authorize involuntary isolation or quarantine when the MCDPH
Commissioner of Public Health or designee has determined that implementing such an order
will not cause an immediate and serious threat to public health or the individual is non-
compliant with a Health Order.
In the event of an outbreak or potential outbreak of a communicable disease in Monroe County that
may require isolation or quarantine beyond day-to-day capabilities, the MCDPH Commissioner of
Public Health or designee shall confer with staff from the MCDPH Division of Epidemiology and Disease
Control Unit, Nursing Services Division, and the Office of Public Health Preparedness (OPHP) to
determine the appropriate Incident Command structure, the need to activate Incident Command and
open the Public Health Operations Center (PHOC), and to consider the need for declaring a Public
Health Emergency.
If it is determined that a local State of Emergency would be appropriate, the MCDPH Commissioner of
Public Health or designee will consult with the Office of Emergency Management (OEM), the County
Executive and the County Attorney and request the County Executive declare a local State of
Emergency. The Emergency Operations Center (EOC) will open if necessary. Cross-jurisdictional issues
are addressed in the Monroe County Mutual Aid Plan.
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CHAPTER 2: PLANNING ASSUMPTIONS
2.1 PLANNING ASSUMPTIONS

Development of the I&Q Plan for MCDPH assumes the following:
• MCDPH may utilize isolation and/or quarantine as one of several tools to reduce the spread of
communicable diseases.
• I&Q planning must incorporate the unique needs of vulnerable populations including, but not
limited to, the economically disadvantaged, homeless, non-English speaking, special need
populations, elderly, incarcerated, etc.
• The ability of MCDPH to implement this Plan is based not only on the number of people and
type of disease suspected, but on the distribution of individuals throughout the County. There
is a difference in supporting a small number of households vs. a large number of households
even if the total number of people affected may be the same.
• All policies and procedures to assure the care of protected health information apply, but
recognize that MCDPH may make necessary disclosures to protect public health.
• Isolation or quarantine may be necessary for residents of other counties who are diagnosed
while in Monroe County. MCDPH will coordinate with neighboring counties to discuss their
plans, but is not responsible for the planning or execution of isolation or quarantine efforts
beyond county lines.
• Large scale isolation/quarantine events will require the participation of many public health
resources as well as coordination with community partners, health care, and first responders
for a successful response.
• An effective public communication program is essential to achieve voluntary compliance with
disease control strategies.
• It is assumed that most of those who are requested to remain in isolation or in quarantine will
be compliant and follow the instruction of MCDPH. MCDPH will check in on a routine basis and
monitor individuals/facilities (based on determined clinical requirements). Information
collected during monitoring may be used as evidence of non-cooperation.
• MCDPH will focus on voluntary compliance from ill or exposed persons and will implement the
least restrictive means possible to reduce the spread of infection realizing involuntary
detention of individuals who pose a threat to the public health may be required for those who
do not cooperate with the request to comply.
• Persons in Monroe County who are isolated or quarantined will be supported to the extent
possible through means such as provision of temporary financial assistance, food and other
necessities.
• MCDPH will, to the extent possible, protect against stigmatization or unwarranted disclosure of
private information, and will support placement in an appropriate facility if the home
environment is unsuitable to isolation or quarantine.
• An event triggering activation of this plan is also likely to involve mobilization of other public
health emergency response capabilities. Consequently, access to these public health resources
(including workforce resources) may be limited.
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CHAPTER 3: ROLES AND RESPONSIBILITIES
3.1 MONROE COUNTY DEPARTMENT OF PUBLIC HEALTH

• Will be the lead agency in the management of a communicable disease outbreak.
• MCDPH Commissioner of Public Health or designee will assess the public health threat, evaluate
the potential consequences, and determine whether isolation and/or quarantine are necessary.
• MCDPH Commissioner of Public Health or designee will take the lead in determining and issuing
isolation or quarantine orders.
• MCDPH Commissioner of Public Health or designee may initiate the isolation or quarantine of
individuals as a protective action to prevent/limit spread to others.
• MCDPH Commissioner of Public Health or designee will make a request through the Office of
Emergency Management to the County Executive to declare a State of Emergency if
appropriate.
• Will seek voluntary cooperation and compliance of infected or exposed individuals.
• To detain uncooperative infected or exposed individuals to protect the health of the
community, the MCDPH Commissioner of Public Health or designee may write a Health Order
for Involuntary Isolation or Quarantine and arrange for delivery of this Order; or make a request
to and assist the County Attorney in obtaining a Court Order for Involuntary Isolation or
Quarantine.
• Will arrange for safe and effective isolation or quarantine and set up a compliance monitoring
plan that addresses the basic needs of individuals placed in isolation or quarantine.
• Will take the lead in coordinating with social service agencies, American Red Cross, businesses,
utilities, community-based organizations, Monroe County Office of Mental Health, faith based
organizations and others to assist with the basic needs of those placed in isolation/quarantine.
This includes food, clothing, shelter, medical care, communication with family members, legal
counsel and others, if needed.
• Will implement local and regional surveillance and disease and health management services
that comply with clinical protocols and federal, state and local regulations, laws and guidelines.
• Will be the lead clinical and administrative manager of any non-hospital isolation or quarantine
facilities that are established.
• Will identify an appropriate placement for individuals who are isolated or quarantined if they
cannot stay at their homes or do not have a suitable home environment. MCDPH will also
arrange transportation to the designated facility if needed.
• Will maintain documentation (as appropriate) on each case, suspected case, or contact to
include Isolation and Quarantine Record, Home or Facility Isolation/Quarantine Checklist,
MCDPH Daily Monitoring Log, and Log of Obstacles to Compliance and Resource Referrals.
• Will inform the Monroe County Attorney of any instances requiring more than routine
isolation/quarantine.
• Annually review this plan (to include appendices) for accuracy and updates.
3.2 MONROE COUNTY ATTORNEY

• Advise the MCDPH Commissioner of Public Health or designee on all legal matters pertaining to
isolation and quarantine.
• Petition the court ex parte to authorize involuntary detention, once need is determined by the
MCDPH Commissioner of Public Health or designee.
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• Represent MCDPH in any petition or appeal hearings required to carry out involuntary isolation
or quarantine.
3.3 MONROE COUNTY SHERIFF’S OFFICE (MCSO)

• Serve Orders for Isolation and Quarantine. A MCDPH staff member will accompany the MCSO
Server to review the terms of the Order, answer clinical questions, complete the assessment
checklist and review the monitoring plan.
• Enforce Orders for involuntary isolation or quarantine in non-compliance cases, if requested by
MCDPH.
• Execute arrest warrants related to I & Q cases, if needed, and provide subsequent transportation to
appropriate I & Q facility.
• Provide escort of vehicle transporting individual under isolation or quarantine, if requested.
• Assist with security during transportation of violent or unruly patients in involuntary isolation or
quarantine if requested by MCDPH.
3.4 OTHER LAW ENFORCEMENT AGENCIES

• Assist with community containment.
• Assist with arrest warrants related to I & Q cases, if needed.
• Assist with security during transportation of patients in involuntary isolation or quarantine if
requested by MCDPH.
3.5 MONROE COUNTY OFFICE OF PROBATION AND CORRECTIONS

• Serve an Order for Isolation or Quarantine only if a Monroe County Sheriff contacts MCDPH and
advises that his office is unable to serve an Order due to a large number of staff absences.
• Provide monitoring equipment, if requested, for individuals who have been served with Isolation or
Quarantine Orders.
3.6 MONROE COUNTY SUPREME COURT

• Receive petitions for court ordered involuntary isolation or quarantine.
• Schedule and hold a hearing for court ordered involuntary isolation or quarantine.
• Issue Court Orders for involuntary isolation or quarantine.
3.7 APPELLATE DIVISION COURT

• Hear appeals from the Monroe County Supreme Court.
3.8 EMERGENCY MEDICAL SERVICES

• Provide transportation of infectious or exposed individuals in coordination with MCDPH if
requested.
3.9 MONROE COUNTY HOSPITALS

• Receive and treat patients requiring isolation or quarantine if requested by MCDPH.
3.10 MONROE COUNTY PHYSICIANS

• Required under NY Public Health Law to report cases of communicable diseases to MCDPH.
• Required under 10 NYCRR 2.27 to isolate a patient with a communicable disease pending official
action by the MCDPH Commissioner of Public Health.
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• Will assist the staff of MCDPH in evaluation of the suspect patient to determine the need for
isolation and/or quarantine and whether a risk of non-compliance exists.
3.11 MONROE COUNTY OFFICE OF EMERGENCY MANAGEMENT

• Participate in discussions and decisions on response to the event.
• Coordinate requests from MCDPH to the County Executive for State of Emergency declarations.
• Coordinate the community response and obtain needed resources and assistance.
• Request additional assets/assistance from other County resources or New York State.
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CHAPTER 4: CONCEPT OF OPERATIONS
4.1 ACTIVATION
• This plan may be activated when isolation and/or quarantine is required to safeguard the
health of people within Monroe County and to stop the spread of a communicable disease.
• MCDPH Division of Epidemiology and Disease Control Unit (EPI/DCU) and/or Nursing Services
Division will recommend to the MCDPH Commissioner of Public Health or designee to authorize
use of isolation and/or quarantine as strategies to control a communicable disease outbreak.
• MCDPH Commissioner of Public Health will authorize the use of isolation and/or quarantine as
strategies to control a communicable disease outbreak when he/she determines that this
strategy is necessary, is consistent with the recommendations of national public health
authorities, and all other resources have been exhausted.
4.2 DIRECTION AND CONTROL

• MCDPH will be the lead in coordinating the local health and medical response to an outbreak
event that may require isolation and/or quarantine.
• MCDPH may operate under the Incident Command System throughout the event (depending
on the size of the event).
• MCDPH may activate the Public Health Operations Center (PHOC) and/or request the activation
of the Monroe County Emergency Operations Center (EOC) to coordinate response during an
outbreak situation.
• MCDPH Commissioner of Public Health may request the County Executive to declare a local
State of Emergency.
• Tuberculosis cases will be managed per the MCDPH Tuberculosis Policies and Procedures for
Delinquent Cases/Suspects which is in accordance with the Monroe County Sanitary Code
Sections 569.77 – 569.88.
• Planning and implementation will be flexible and scalable in order to respond appropriately to
the size and nature of the outbreak. The following general guidelines will apply; however, they
are subject to review and approval of the MCDPH Commissioner of Public Health:
4.2.1 Small Scale Outbreak (less than 10 isolated/quarantined individuals): Members of MCDPH staff
will make daily home visits and/or phone calls to monitor compliance.
4.2.2 Medium Scale Outbreak (greater than 10/less than 50 individuals)

• MCDPH Commissioner of Public Health will assess programs/patient services that must be
continued during the emergency based on the MCDPH Continuity of Operations Plan (COOP).
All other programs/projects will be temporarily suspended following guidance in the COOP.
• MCDPH Commissioner of Public Health may coordinate with the Office of Emergency
Management (OEM) to request the County Executive declare a local State of Emergency.
• MCDPH Commissioner of Public Health may request OEM to activate the EOC.
• MCDPH Commissioner of Public Health may request the County Executive to activate the
Monroe County Medical Reserve Corps.
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4.2.3 Large Scale Outbreak (greater than 50 isolation/quarantine individuals):
• The MCDPH Commissioner of Public Health will activate the MCDPH Public Health Emergency
Preparedness and Response (PHEPR) plan.
• MCDPH Commissioner of Public Health may request Office of Emergency Management (OEM)
to activate the County Emergency Operations Center (EOC).
• Mutual aid from surrounding counties will be requested, if needed.
• State or Federal assistance requests will be made in accordance with established policy and
procedures through the County’s Office of Emergency Management.
4.3 HEALTH ORDER VS. COURT ORDER

• Health Order: If the MCDPH Commissioner of Public Health or designee determines that there
is a need for involuntary isolation or quarantine after reviewing all of the compliance
documentation and that a delay of 2-3 days may cause an immediate or serious threat to
public health, the MCDPH Commissioner of Public Health or designee will then prepare and
issue a Health Order for Isolation or Quarantine. (Chapter 6) (NOTE: if a Health Order is issued,
a Court Order is required in order to detain a person for longer than 24 hours).
• Court Order: If the MCDPH Commissioner of Public Health determines that a delay of 2-3 days
will not cause an immediate or serious threat to public health, the MCDPH Commissioner of
Public Health or designee will contact the Monroe County Attorney and request the
preparation of a Petition for a Court Order for Isolation or Quarantine. (Chapter 7)
4.4 REQUESTING STATE OF EMERGENCY

In the event of an outbreak or potential outbreak in Monroe County of a communicable disease as
defined in NYS Sanitary Code 10 NYCRR 2.1(a), the MCDPH Commissioner of Public Health or designee
will assess the situation and meet with key staff. A discussion and decision will be made about the
need to declare a County State of Emergency (see note below). If such an emergency declaration is
deemed necessary, the MCDPH Commissioner of Public Health will consult with the OEM, the County
Executive and the County Attorney and request the County Executive declare a Local State of
Emergency.
NOTE: only the Federal Secretary of the Department of Health and Human Services may declare a
public health emergency under section 319 of the Public Health Services Act.
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CHAPTER 5: PROTOCOL FOR VOLUNTARY ISOLATION AND QUARANTINE
5.1 LEGAL DOCUMENTS UTILIZED FOR VOLUNTARY ISOLATION AND QUARANTINE

• Voluntary Isolation Agreement
• Voluntary Quarantine Agreement
5.2 DETERMINATION OF NEED FOR VOLUNTARY ISOLATION OR QUARANTINE

• Upon receipt of a request for voluntary isolation or quarantine by community providers or
MCDPH staff, the MCDPH Commissioner of Public Health or designee will review the
information gathered by MCDPH staff on the clinical diagnosis, the infectious disease, the mode
of transmission, and the reported behavior of the individual.
• Based on the results of the investigation, the MCDPH Commissioner of Public Health or
designee will determine if isolation or quarantine measures are necessary to control a
communicable disease.
• As part of the review of the information gathered by MCDPH above, the MCDPH Commissioner
of Public Health or designee will determine the risk of non-compliance. If the risk of non-
compliance is minimal, the MCDPH Commissioner of Public Health may determine that
voluntary isolation or quarantine is appropriate.
5.3 NOTIFICATION FOR VOLUNTARY ISOLATION OR QUARANTINE

• If the MCDPH Commissioner of Public Health or designee determines that voluntary isolation is
appropriate, this will be formally communicated with a written request.
• The MCDPH Commissioner of Public Health or designee will request a MCDPH staff member to
deliver the Voluntary Isolation/Quarantine Agreement letter to the individual along with the
Patient Packet which includes specific information on the disease, instructions and checklists
for isolation and a log sheet for symptom and fever monitoring (if appropriate).
• MCDPH staff member will review the information in the letter with the individual, stress the
importance of compliance, complete the Home or Community-Based Facility
Isolation/Quarantine Checklist and discuss with the individual his/her needs that must be met
in order for compliance to occur.
• MCDPH staff member will ask the individual to sign the Voluntary Isolation/Quarantine
Agreement Letter (if appropriate).
• If interpreter/translator services are needed, MCDPH staff will coordinate with interpreter/
translator services.
• Depending on the circumstances, it may be necessary to communicate the request by an
alternate means. Alternate means of communicating the request include:
 Sending a letter by certified mail.
 Sending a message by e-mail or fax.
 Telephone call to the individual, parent or other responsible party.
5.4 CONTENTS OF THE AGREEMENT LETTER REQUESTING VOLUNTARY ISOLATION OR QUARANTINE

The letter will contain:
• Name of the person or premise.
• A description of the disease.
• The mode of transmission of the disease.
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• The location and dates of isolation or quarantine.
• Infection control methods that will prevent its spread.
• The dangers and medical consequences of failing to adhere to the infection control methods
(e.g. others will become ill).
• The name of the Case Manager – the staff member from the MCDPH that will act as contact,
monitor compliance and make referrals to resources as needed.
• A description of the specific actions and/or behaviors that will constitute voluntary isolation or
quarantine (method of isolation or quarantine).
• A description of specific actions and/or behaviors that the MCDPH Commissioner of Public
Health or designee will assess to determine non-compliance.
• The legal consequence of non-compliance which may be involuntary confinement through the
issuance of a Health Order or Court Order for involuntary isolation or quarantine.
• The individual’s right to be represented by legal counsel or to have counsel provided. If the
individual qualifies to have counsel provided, such counsel will be made available upon request
and the determination of the Court.
5.5 METHOD OF ISOLATION OR QUARANTINE

• The method of voluntary isolation or quarantine will be made in accordance with best practices
or guidelines from the New York State Department of Health (NYSDOH) or the Federal Centers
for Disease Control and Prevention (CDC).
• The individual will be requested to sign the Voluntary Isolation or Quarantine Agreement Letter
indicating understanding of restrictions and agreeing to comply (if needed – disease
dependent).
5.6 TRANSPORTATION OF PATIENTS

• The MCDPH Commissioner of Public Health, designee or MCDPH Case Manager will determine
the need for transportation of individuals from the location of isolation or quarantine.
• Transportation of individuals in voluntary isolation or quarantine will be arranged by MCDPH
using MCDPH transport or EMS services. Infection control procedures and personal protective
equipment (PPE) will be provided by MCDPH.
5.7 PROTECTION OF HEALTH WORKERS AND HOUSEHOLD MEMBERS

• The MCDPH Commissioner of Public Health or designee will define the appropriate practices
and PPE necessary for protection of health workers and household members providing care to
patients in voluntary isolation, quarantine or facilities that are voluntarily quarantined based on
CDC guidelines.
• MCDPH will arrange for the training of the workers or household members and will make
available appropriate PPE.
5.8 PERSONAL NEEDS OF PATIENTS

• The MCDPH Case Manager shall assure that arrangements are in place to provide medical
treatments, food, and comfort measures to patients in voluntary isolation or quarantine.
• A review of any potential obstacles to compliance or needs of other household members are
addressed when isolation and quarantine measures are initiated by the MCDPH Case Manager
and as needs arise.
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• Numerous resources are listed in Appendix I to meet the individual’s needs and to provide
options in case one of the resource’s limits is exceeded. If all resources are exceeded,
assistance will be requested through OEM.
5.9 COMPLIANCE MONITORING PLAN

• The MCDPH Commissioner of Public Health or designee will assign a MCDPH Case Manager and
outline a plan to monitor and document compliance with the request for voluntary isolation or
voluntary quarantine, defining compliance and non-compliance in specific terms.
• The MCDPH Case Manager will make contact (frequency is disease dependent) in person or by
phone with the exposed or infected individual to monitor their health status and to evaluate,
review and address obstacles to compliance with the individual.
• The steps to address compliance concerns may include an additional personal contact with the
individual by MCDPH staff, assurance that measures needed to support their basic needs, such
as meals, are in effect; as well as identification/referral to resources to resolve other concerns.
5.10 NON-COMPLIANCE WITH A REQUEST FOR VOLUNTARY ISOLATION OR QUARANTINE

• If after reviewing the reasons for non-compliance and trying to remedy the situation, the
MCDPH Case Manager assigned determines there is continued non-compliance, the MCDPH
Case Manager will notify the MCDPH Commissioner of Public Health or designee who will
investigate the need for a Health Order or Court Order.
5.11 DOCUMENTATION
• The MCDPH Case Manager assigned to monitor compliance will document the contact with the
individual, the individual’s compliance or non-compliance and the appropriate information
related to the individual’s health.
• A copy of the signed Voluntary Isolation/Quarantine Agreement Letter will be kept in the
individual’s case file, along with any additional information specific to the initiation of voluntary
isolation/quarantine such as resources that were requested for meeting the individual’s needs
while isolated/quarantined.
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CHAPTER 6: PROTOCOL FOR INVOLUNTARY ISOLATION OR QUARANTINE – HEALTH
ORDER
6.1 LEGAL DOCUMENTS UTILIZED FOR INVOLUNTARY ISOLATION OR QUARANTINE – HEALTH ORDER
• Health Order for Isolation
• Health Order for Quarantine
• Verification
• Order to Show Cause
• Petition to Court – Isolation
• Petition to Court – Quarantine
6.2 DETERMINATION OF NEED FOR INVOLUNTARY ISOLATION OR QUARANTINE

• Upon receipt of a request for involuntary isolation or quarantine by MCDPH staff or community
providers, the MCDPH Commissioner of Public Health or designee will review the information
gathered including the clinical diagnosis, the infectious disease, the mode of transmission, the
reported behavior of the patient and whether there has been a previous request for voluntary
isolation or quarantine;
• Based on the results of this investigation, the MCDPH Commissioner of Public Health or
designee will determine if involuntary isolation or quarantine measures are necessary to
control a communicable disease;
• In the event that there has been a previous request for voluntary isolation or quarantine and a
MCDPH Case Manager has reviewed with the individual the reasons for the non-compliance
and tried to remedy the situation but the non-compliance continues, the MCDPH Commissioner
of Public Health or designee may determine involuntary isolation or quarantine is appropriate;
• In the event that there has not been a previous request for voluntary isolation or quarantine,
but the MCDPH Commissioner of Public Health or designee has determined that there is a
significant risk of non-compliance, then the MCDPH Commissioner of Public Health or designee
may determine that involuntary isolation or quarantine is appropriate.
6.3 ISSUING A HEALTH ORDER FOR INVOLUNTARY ISOLATION OR FOR QUARANTINE

• If, by reviewing compliance plan documentation, the MCDPH Commissioner of Public Health or
designee determines the individual is non-compliant with voluntary isolation or quarantine, a
Health Order for isolation or quarantine may be prepared and issued without first obtaining
Court approval if any delay in the isolation or quarantine of the person/premises would cause
an immediate or serious threat to the public health.
• The Health Order will specify the identity of the individual(s) subject to isolation or quarantine
or the premises subject to isolation or quarantine; the location the individual is to remain at;
the date and time at which isolation or quarantine commences; and the suspected highly
contagious/possibly fatal disease.
• The Health Order will contain provisions advising the individual(s) of the legal authority, the
purpose for isolation or quarantine, the procedure for a Court hearing and the rights available
to isolated or quarantined individual(s) including the right to appeal the Order by filing a
written application for review within ten days of the Health Order. The individual is notified of
his/her right to an attorney.
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• If the situation requires a Court Order be obtained after a Health Order has been served, the
County Attorney will file as soon as possible but within 5 business days after service of a Health
Order, an Order to Show Cause/Petition for a Court Order authorizing the initial or continued
isolation or quarantine and an expedited hearing to continue isolation or quarantine. The
detention shall not continue for more than 10 business days after the filing of the Petition in
the absence of the scheduling of a hearing for a court order authorizing such isolation or
quarantine. Moreover, the MCDPH Commissioner of Public Health must obtain a Court Order
authorizing continued isolation or quarantine.
6.4 SERVING A HEALTH ORDER FOR ISOLATION OR QUARANTINE

• The MCDPH Commissioner of Public Health or designee will contact the Monroe County
Sheriff’s Office (MCSO) to serve the Health Order and review the terms of the Order with the
individual.
• A MCDPH staff member will accompany the MCSO Server and explain the importance of
complying with isolation or quarantine (both orally and in written form). The MCDPH staff
member will answer any clinical questions, complete the Home or Facility Isolation or
Quarantine Checklist if not done previously, and review the monitoring plan and the means of
communication with the health department. The MCDPH staff member will also evaluate the
security needs at this time.
• If it is apparent that the individual will not be compliant, the Server or the MCDPH staff
member will notify the MCDPH Commissioner of Public Health and request law enforcement to
assist in moving the individual to a pre-identified isolation or quarantine site that has the
appropriate monitoring and security in place.
• The MCDPH Commissioner of Public Health or appropriate staff will review with the MCSO
Server the methods to avoid exposure and will provide the needed personal protective
equipment.
6.5 HEARING
• The County Attorney will file court papers and the Monroe County Supreme Court will schedule
a hearing.
• Hearings will be held at the Monroe County Hall of Justice, Rochester, NY, unless otherwise
ordered by the Court.
• The MCDPH Commissioner of Public Health or designee will make a recommendation about an
appropriate location to hold the hearing based on the circumstances to ensure minimal
exposure.
• If the respondent cannot appear in court, MCDPH will advise and coordinate with the Court for
alternative arrangements, (e.g. video conferencing, arraignment in Airborne Infection Isolation
Room (AIIR) using appropriate infection control precautions, or other location utilizing portable
High Efficiency Particulate Air (HEPA) filtering device). This will be determined on a case-by-case
basis. The County Attorney will appear in Court to advise and represent the MCDPH
Commissioner of Public Health.
• The MCDPH Commissioner of Public Health, designee, or staff will be responsible for identifying
the appropriate precautions, ensure training, provide the needed PPE for personnel involved,
and assist with arrangements for site decontamination if needed.
• The MCDPH Commissioner of Public Health or designee will determine if the individual should
be held in a different location from the site of confinement pending the hearing. This location
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• will be identified prior to the hearing and may be at the individual’s home with increased
monitoring, an AIIR in one of the Monroe County hospitals, an identified isolation or quarantine
facility that has the appropriate monitoring and security in place or Monroe Community
Hospital (435 East Henrietta Road, Rochester, NY).
• The individual will be notified of his/her right to appeal during the hearing process.
6.6 METHOD OF INVOLUNTARY ISOLATION OR QUARANTINE

• The method of involuntary isolation or quarantine will be made in accordance with best
practices or guidelines from the New York State Department of Health (NYSDOH), although
consultation with NYSDOH is not required unless there is potential for a large outbreak or an
unusual disease.
• The method of involuntary isolation or quarantine that is employed will be the “least restrictive
measure”.
• Depending on the nature of the infectious disease and the treatment needed, the MCDPH
Commissioner of Public Health or designee shall determine the location for isolation or
quarantine, which may be:
 Individual’s home or that of a family member with increased monitoring using telephones,
videoconferencing, electronic bracelet monitoring system or increased visits by MCDPH
staff,
 Airborne Infection Isolation Room (AIIR) at one of the Monroe County hospitals or,
 Facility(s) pre-identified by the MCDPH Commissioner of Public Health that has appropriate
surveillance and security in place.
• The MCDPH Commissioner of Public Health or designee will determine where the individual(s)
will be held while the facility is being prepared. This may be at a Monroe County hospital or
Monroe Community Hospital.
• The MCDPH Case Manager will assure that the basic needs of the individual(s) are met using
community partners as resources.
• MCDPH will work with OEM and other collaborative partners in securing facilities that can
accommodate mass isolation and/or quarantine. The facility staff will provide the cleaning and
upkeep of these facilities if possible. If the facility staff is unable to provide these services, OEM
will be consulted to assist with arranging the services from outside agencies.

• The MCDPH Commissioner of Public Health or designee will determine the need for
transportation of an individual from the site of confinement and/or hearing.
• Transportation of such individuals will be arranged by the MCDPH Case Manager using MCDPH
transport or EMS services.
• A representative of a local law enforcement agency will accompany the transporter if it is
anticipated that the individual will be unruly or violent.
• The MCDPH Commissioner of Public Health or appropriate staff will review with the transporter
and law enforcement official ways to avoid exposure, provide the required PPE if necessary and
assist with the directions for decontamination of the vehicle if needed.
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6.8 PROTECTION OF HEALTH CARE WORKERS AND HOUSEHOLD MEMBERS
• The MCDPH Commissioner of Public Health will follow the CDC guidelines to define the
appropriate practices and personal protective equipment necessary for protection of health
workers and household members providing care to individuals or facilities that are involuntary
isolated or quarantined.
• MCDPH staff will arrange for the training of the workers or household members and will make
available appropriate PPE
• MCDPH staff will coordinate with a Certified Infectious Control (CIC) staff member to provide
technical assistance with training and PPE information required as mentioned above.

• The MCDPH Commissioner of Public Health or designee will outline a plan for monitoring
compliance with the Health Order for isolation or quarantine, defining compliance and non-
compliance in specific terms.
• The MCDPH Commissioner of Public Health will assign MCDPH staff to be Case Managers to
monitor and document compliance.
• The plan will require the MCDPH Case Manager to have daily contact with the individual or the
person responsible for the premises by telephone, video-conference or in person to evaluate
their health, to review and address any reasons for non-compliance and try to remedy the
situation if possible. This may include an additional personal contact with the individual by
MCDPH staff, assurance that the measures needed to support the basic needs of the individual
in quarantine or isolation, such as meals, are in effect, and the identification and referral to
resources to resolve other concerns leading to non-compliance (ex. American Red Cross,
Salvation Army, etc.).
• The MCDPH Commissioner of Public Health, designee or MCDPH staff will inform the law
enforcement agency with jurisdiction to participate in the Compliance Monitoring Plan as
needed.
6.10 ENFORCEMENT OF ORDER

• MCDPH will partner with the local law enforcement agencies as needed to enforce Orders with
unruly or violent individuals.
• MCDPH Case Manager or staff monitoring compliance will determine the security required by
assessing the actions, physical and mental status of the individual(s), the number of individuals
and the location of the site of confinement being used for isolation or quarantine.
• If the individual is ordered to remain at home with increased monitoring/surveillance and it
becomes apparent that the individual is non-compliant, the MCDPH Case Manager will consult
with the MCDPH Commissioner of Public Health, contact law enforcement and arrange
transport of the individual to a pre-identified facility with the appropriate monitoring and
security.
• If the individual is in a hospital, law enforcement will provide the support necessary to enforce
the isolation or quarantine promptly upon the hospital’s request.
• When a pre-identified facility is used, the facility security staff will be utilized to monitor the
individual with law enforcement assisting if needed. If the facility has no security staff or the
staff is unable to provide the service, OEM or other appropriate agency will be consulted to
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assist with arranging security staff from an outside security agency and MCDPH will request
local law enforcement assistance with unruly or violent patients.
• The MCDPH Commissioner of Public Health or appropriate staff will review infection control
procedures with security personnel and law enforcement agencies and provide the needed PPE.
6.11 NON-COMPLIANCE WITH A HEALTH ORDER

• If after reviewing the reasons for the non-compliance and trying to remedy the situation, the
MCDPH Case Manager assigned to monitor compliance assesses that the individual continues to
be non-compliant with the Health Order, the MCDPH Commissioner of Public Health or
designee will be consulted.
• If after reviewing all of the documentation the MCDPH Commissioner of Public Health or
designee determines that non-compliance is occurring, the MCDPH Commissioner of Public
Health in consultation with the County Attorney and the District Attorney, will examine the
following options:
 Commencement of an action pursuant to NY PHL Section 12(b) for willful violation of
the Health Order, or
 Commencement of a special proceeding to obtain a Court Order for involuntary
isolation or quarantine.
6.12 DOCUMENTATION
The MCDPH Case Manager assigned to monitor compliance will document:
• Contacts with the individual,
• Individual’s compliance or non-compliance,
• Appropriate information related to the individual’s health,
• Information about the resources obtained to assist with compliance issues.
This documentation will be available for use by the County Attorney and the MCDPH Commissioner of
Public Health in determining the next steps.
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CHAPTER 7: PROTOCOL FOR INVOLUNTARY ISOLATION OR QUARANTINE BY COURT
Order
Legal Documents Utilized for Court Order for Involuntary Isolation or Quarantine:
• Request for Judicial Intervention.
• Order for the Respondent to Show Cause Why an Order for Isolation or Quarantine Should Not
Be Made or Continued.
• Petition to Show Cause for Isolation or Quarantine.
• Affidavit by the MCDPH Commissioner of Public Health or his designee for Order for Isolation.
• Order for Continuing Isolation or Quarantine.
7.1 OBTAINING A COURT ORDER FOR INVOLUNTARY ISOLATION OR QUARANTINE

If the MCDPH Commissioner of Public Health determines that obtaining a Court Order for isolation or
quarantine will not result in a delay that would pose an immediate or serious threat to the public
health, or if the individual is non-compliant with a Health Order, the MCDPH Commissioner of Public
Health will review with the Monroe County Attorney the individual’s compliance documentation
record, medical records (including lab reports) and physician affidavits, if necessary. If it is determined
that a Court Order is needed, the County Attorney will prepare the necessary documents to seek a
Court Order for isolation or quarantine.
7.2 PETITION/ORDER TO SHOW CAUSE FOR ISOLATION OR QUARANTINE

The Petition shall provide the following:
• Identity of person or group of persons subject to isolation or quarantine.
• Premises subject to isolation or quarantine if applicable.
• Date and time at which isolation or quarantine commences.
• The suspected communicable disease.
• A statement of compliance with the conditions and principles for isolation and quarantine
(including the location at which the isolation or quarantine will occur).
• A statement of the basis on which isolation or quarantine is justified.
7.3 AFFIDAVIT OF THE COMMISSIONER

The Petition must be accompanied by the sworn affidavit of the MCDPH Commissioner of Public Health
or his designee attesting to the facts asserted in the Petition, together with further information that
may be relevant and material to the Court’s consideration.
7.4 PROCEDURE FOR FILING THE PETITION/ORDER

The County Attorney will notify the Administrative Judge, Monroe County Supreme Court, 545 Hall of
Justice, Rochester, NY 14614 (585-371-3752) and arrange for delivery of the Petition. The
Administrative Judge will determine which Justice will receive the Petition.
The Monroe County Attorney will convey the level of contagiousness of the patient and the need for
special infection control measures to be taken at a hearing.
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7.5 SERVING THE ORDER TO SHOW CAUSE PETITION AND SUPPORTING PAPERS ON AN INDIVIDUAL
OR RESPONSIBLE PARTY
• The Petition and supporting papers will be served upon the individual(s) so
isolated/quarantined within the time specified by the Court in the signed Order to Show Cause
and in accordance with the New York Civil Practice Law and Rules.
• The County Attorney will contact the Monroe County Sheriff’s Office to serve the papers and
review the terms of the Order with the individual.
• The papers shall advise the individual(s) to be isolated or quarantined that he/she has the right
to a hearing and the right to arrange to be represented by counsel.
• The MCDPH Commissioner of Public Health or appropriate MCDPH staff will review with the
process Server (if different Law Enforcement staff) and the law enforcement official ways to
avoid exposure and provide the needed PPE.
• A MCDPH staff member will accompany the process Server to answer any clinical questions and
describe the means of communication with the Health Department.
7.6 HEARING
• The Supreme Court Justice will schedule a hearing.
• Hearings will be held at the Monroe County Hall of Justice, Rochester, NY unless otherwise
ordered by the Court.
• The MCDPH Commissioner of Public Health will make a recommendation about an appropriate
location to hold the hearing based on the circumstances to ensure minimal exposure.
• The Court and the MCDPH will arrange for video-conferencing capabilities when and if the need
arises. This will be determined on a case-by-case basis.
• The County Attorney will appear in Court to advise and represent the MCDPH Commissioner of
Public Health.
• The MCDPH Commissioner of Public Health or appropriate staff will be responsible for
identifying the appropriate infection control precautions, obtaining needed PPE, providing
training for personnel involved, and assisting with arrangements for site decontamination.
• The MCDPH Commissioner of Public Health or designee will determine if the individual will be
held in a different location from the site of confinement pending the hearing. The site may be
at home, a hospital, a facility pre-identified by the MCDPH Commissioner of Public Health or
Monroe Community Hospital (435 East Henrietta Road, Rochester, NY 14620).
• The Court shall grant the petition if, by a standard of “clear and convincing evidence”, isolation
or quarantine is shown to be reasonably necessary to protect public health.
• The Court shall grant any other relief it deems necessary and appropriate under the particular
circumstances of the case.
7.7 COURT ORDER FOR ISOLATION OR QUARANTINE

A Court Order authorizing isolation or quarantine may do so for a period not to exceed 60 days. The
order will:
• Identify the isolated or quarantined person(s) by name or shared or similar characteristics or
circumstances.
• Specify factual findings warranting isolation or quarantine, including any conditions necessary
to ensure that isolation or quarantine is carried out within the stated purposes of this
procedure.
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• The New York State Supreme Court, Appellate Division, Fourth Department, will be the court
that hears challenges to the Order.
7.8 SERVING THE COURT ORDER FOR ISOLATION OR QUARANTINE

• The Monroe County Sheriff’s Office will be notified by the Monroe County Attorney to serve the
Court Order within the time frame specified by the Court.
• The Server will review the terms of the Order and advise the individual of his/her right to an
appeal and the right to an attorney.
• A MCDPH staff member will accompany the Server and explain the importance of complying
with isolation or quarantine (both orally and in written form). The staff member will answer any
clinical questions, review the monitoring plan and describe the means of communication with
the health department. The staff person will also advise the individual(s) to be detained that
he/she may supply addresses and/or telephone numbers of friends and/or relatives to receive
notification of the individual’s isolation/quarantine and that MCDPH shall, at the individual’s
request, provide notice to a reasonable number of such people that the individual is being
isolated/quarantined.
• The MCDPH Commissioner of Public Health or appropriate staff will review with the Server and
the law enforcement official ways to avoid exposure and recommend appropriate PPE.
7.9 CONTINUATION OF COURT ORDER FOR ISOLATION OR QUARANTINE

• Prior to the expiration of the Court Order, MCDPH may move to continue said isolation or
quarantine for an additional period, not to exceed 60 days.
• The Court shall grant the motion if isolation or quarantine is shown to be reasonably necessary
to protect public health.
• An individual(s) isolated or quarantined pursuant to this protocol may apply to the Court for an
Order to Show Cause seeking a hearing as to why the individual(s) should not be released.
• If the Court grants the application, the County will request the Court to schedule a hearing on
the Order to Show Cause within 3 days after it issues the Order to Show Cause.
• The issuance of an Order to Show Cause does not stay or enjoin Court Order.
7.10 CONSOLIDATION OF CLAIMS INTO GROUPS

In any proceedings brought pursuant to this protocol, to promote the fair and efficient operation of
justice and having given due regard to the rights of the affected individual(s), the protection of the
public’s health, the severity of the emergency and the availability of necessary witnesses and evidence,
the Court may order the consolidation of individual claims into groups of claims if it determines:
• The number of individuals involved or to be affected is so large as to render individual
participation impractical.
• There are questions of law or fact common to the individual claims or rights to be determined.
• The group claims or rights to be determined are typical of the affected individual’s claims or
rights.
• The entire group will be adequately represented in the consolidation.
7.11 METHOD OF INVOLUNTARY ISOLATION OR QUARANTINE

• The method of involuntary isolation or quarantine will be made in accordance with best
practices or guidelines from the NYSDOH and/or the CDC.
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• The method of involuntary isolation or quarantine that is employed will be the “least restrictive
measure”.
• Depending on the nature of the infectious disease and the treatment needed, the MCDPH
Commissioner of Public Health or designee shall determine the location for isolation or
quarantine with assistance from OEM if needed. This location will be based on the least
restrictive measure and may include:
 Individual’s home or that of a family member with increased monitoring using
telephones, video-conferencing or increased visits by MCDPH staff.
 Airborne Infection Isolation Room (AIIR) at one of the Monroe County Hospitals.
 Facility pre-determined by the MCDPH Commissioner of Public Health that has
appropriate surveillance and security in place. If the facility has no security staff or the
staff is unable to provide the service, OEM will be consulted to assist with arranging
security staff.
 Facility with staff to provide the cleaning and upkeep of these facilities if possible. If the
facility is unable to provide this service, OEM will be consulted to assist in arranging this
service.
• MCDPH Commissioner of Public Health or designee will determine where the individual(s) will
be held while the facility is being prepared, which may be at a Monroe County hospital or
Monroe Community Hospital.
• MCDPH Case Manager assigned will assure that the basic needs of these individuals are met by
using community partners as resources.

At the conclusion of the Court hearing, the MCDPH Commissioner of Public Health or MCDPH Case
Manager will request and arrange transportation of the individual to the court-designated site of
confinement using a MCDPH transport or EMS services. A representative of a local law enforcement
agency will accompany the person transporting the patient if it is anticipated the individual will be
unruly or violent.
The MCDPH Commissioner of Public Health or appropriate staff will review with the transporter and
law enforcement official ways to avoid exposure, provide the required PPE if necessary and assist with
the directions for decontamination of the vehicle if needed.
7.13 PROTECTION OF HEALTH WORKERS AND HOUSEHOLD MEMBERS

The MCDPH Commissioner of Public Health or appropriate MCDPH staff will define the appropriate
practices and PPE necessary for protection of health workers and household members providing care
to individuals in involuntary isolation or facilities that are involuntarily quarantined.

• The MCDPH Commissioner of Public Health or designee will assign a MCDPH Case Manager and
outline a plan to monitor and document compliance with the Court Order for isolation or
quarantine, defining compliance and non-compliance in specific terms.
• MCDPH Case Manager will have routine contact (based on determined clinical requirements)
with the exposed/infected individual or the individual responsible for the premises in person,
by telephone or video-conference to monitor their health status and to evaluate, review and
address reasons for any non-compliance and try to remedy the situation if possible. This may
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include an additional personal contact with the individual by the MCDPH staff, assurance that
measures needed to support the basic needs of the person, such as food, are in effect; as well
as the identification and referral to resources to resolve other concerns that are leading to non-
compliance.
• The MCDPH Commissioner of Public Health will inform the law enforcement agency with
jurisdiction to participate in the Compliance Monitoring Plan as needed.
• If it is determined that non-compliance is occurring after reviewing all documentation and the
individual can no longer be safely isolated or quarantined at their current location, the MCDPH
Commissioner of Public Health or designee may:
 Consult with local hospital administrators about arranging for appropriate hospital
admission for an individual who is ill, or
 Contact a pre-identified isolation and quarantine facility where appropriate monitoring
can occur and arrange transport.
• Define the role for law enforcement agencies in the event of non-compliance.
• Law enforcement can safely detain patients that violate orders in the controlled environment of
a hospital or identified facility.
7.15 ENFORCEMENT PLAN

• MCDPH will partner with local law enforcement agencies as needed to enforce Orders with
unruly or violent patients.
• The MCDPH Case Manager/staff member monitoring compliance will determine the security
required by assessing the action, physical and mental status of the individual(s), the number of
individuals and the location of the site of confinement being used for isolation or quarantine.
• If the individual is ordered to remain at home with increased monitoring/surveillance and it
becomes apparent that the individual is non-compliant, the MCDPH Case Manager will consult
the MCDPH Commissioner of Public Health or designee, contact law enforcement and arrange
transport of the individual to a pre-identified facility with the appropriate monitoring and
security.
• If the individual is in a hospital, law enforcement will provide the support necessary to enforce
the isolation or quarantine promptly upon the hospital’s request.
• When a facility is used, the facility security staff will be utilized to monitor the individual with
law enforcement assisting, if needed.
• If the facility has no security staff or the staff is unable to provide the service, OEM will be
consulted to assist with arranging security staff from an outside security agency and MCDPH
will request local law enforcement assistance with unruly or violent patients.
• The MCDPH Commissioner of Public Health or appropriate staff will review with security
personnel and law enforcement agencies infection control procedures and provide the needed
PPE.
7.16 NON-COMPLIANCE WITH A COURT ORDER

• If after reviewing the reasons for non-compliance and trying to remedy the situation, the
MCDPH staff assigned assess that there is continued non-compliance with Court Ordered
involuntary isolation or quarantine, they will notify the MCDPH Commissioner of Public Health
or designee.
25
Rev. 11 (02/01/2020)
• If the MCDPH Commissioner of Public Health determines that non-compliance is still occurring,
the MCDPH Commissioner of Public Health will contact the County Attorney about possible
next steps, including the following options:
 Bringing a motion in Supreme Court for civil contempt, and seeking a fine or imprisonment,
pursuant to New York Consolidated Laws - Civil Practice Law & Rules Section 5104 (NY CPLR
§5104) and New York Judiciary Law 753 (NY Jud L §753) (prosecuted by County Attorney's
Office).
 Bringing a motion in Supreme Court for criminal contempt, and seeking a fine or
imprisonment, pursuant to NY Jud L §750-751 (prosecuted by County Attorney's Office).
7.17 DOCUMENTATION
The MCDPH Case Manager assigned to monitor compliance will document:
• Contacts with the individual.
• Individual’s compliance or non-compliance.
• Appropriate information related to the individual’s health.
• Information about the resources that were obtained to assist with compliance issues.
This documentation will be available for use by the County Attorney and the MCDPH Commissioner of
Public Health in determining the next steps throughout the Isolation and Quarantine process.
26
Rev. 11 (02/01/2020)
APPENDICES
Appendix A Legal Documents
Appendix B Contact Information for Key Personnel
Appendix C Alternate Sites to Hold Hearings
Appendix D Alternate Isolation and Quarantine Sites
Appendix E Monroe County Department of Public Health

Isolation and Quarantine Record
Appendix F Home or Facility Isolation/Quarantine Checklist
Appendix G Health Department Daily Monitoring Log
Appendix H Log of Obstacles to Compliance and Resource Referrals
Appendix I Support Services
Appendix J Environmental Decontamination Agencies
Appendix K Patient Information Packet
Appendix L Communicable Disease List/Quarantinable Diseases
Appendix M MCDPH Tuberculosis Control Program – Delinquent Cases/Suspects Procedures
Appendix N Acronyms
IQ Appendices TOC (2/20)

Appendix A-i Legal Documents
Attachment A-1……... Sample Voluntary Isolation Agreement

Attachment A-2……... Sample Voluntary Quarantine Agreement
Attachment A-3……... Sample Health Order for Isolation
Attachment A-4……... Sample Health Order for Quarantine
Attachment A-5……... Verification
Attachment A-6……... Sample Request for Judicial Intervention
Attachment A-7……... Sample Motion for Order to Show Cause
Attachment A-8……... Sample Petition to Court – Isolation
Attachment A-9……... Sample Petition to Court – Quarantine
Attachment A-10……. Sample Affidavit in Support of the Petition – Isolation
Attachment A-11……. Sample Affidavit in Support of the Petition – Quarantine
Attachment A-12……. Sample Cause Order for Continuing Isolation or Quarantine
IQ A TOC (2/20)
Voluntary Isolation Agreement
To:
From:
Monroe County Department of Public Health
RE: Voluntary Isolation of _____________________________
(Person)
Date: _____________________
Pursuant to Public Health Law, the Monroe County Department of Public Health (MCDPH) and its Commissioner are
required to protect the public from the danger of communicable diseases.
It has been determined that you have been identified as having _________, a communicable disease that has the
potential to adversely affect the health of the public. It is very important that you take precautions to prevent the
spread of your illness to others. Therefore, your compliance is requested. You are requested to remain in isolation at
______________________________ until you are no longer considered contagious or until further notice from MCDPH.
Please read this agreement carefully and follow the enclosed recommendations. MCDPH is requesting that you stay
home from work, school, child care and other public areas until we notify you that isolation is no longer needed and it is
safe to resume your normal activities. This time period usually lasts for ______________. We understand that this
may cause significant inconvenience to you; however, it is very important for the protection of your own health and that
of others that you abide by this request for isolation.
We are including information on what you can do to help prevent the spread of ________ to others, including your
household contacts. You or your legal guardian may contact the following MCDPH representative to request assistance
in complying, seek relief from, clarification of, or further explanation of the conditions contained in any part of this
agreement. __________________________ (____)____-________
(Name of MCDPH contact person) (Daytime telephone #)
Failure to comply with this request may result in the issuance of a Health Order or a Court Order enforced by MCDPH
and/or law enforcement officials. Willful breach of a Court Order may be considered contempt of Court and may result
in criminal prosecution. In the event of a Health Order or Court Order, you are entitled to the following forms of Due
Process:
1. Right to adequate notice (a written order)
2. Right to a hearing
3. Right to counsel (will be provided if indigent)
4. Right to appeal the final decision
 I agree to a 911 premise warning which notifies emergency workers to contact MCDPH before entering this location.
The provisions of this agreement have been explained to me by the MCDPH representative and I fully understand that
my failure to follow these guidelines or to voluntarily remain in isolation may result in my being placed in involuntary
isolation or committed to a facility where I may be isolated against my wishes.
________________________________ ___________________________ Date: _____________

(Print Name) (Signature)
________________________________ ___________________________ Date: ________________

(Print name of MCDPH representative) (Signature)
Enclosure: Isolation Guidelines, Disease Information Sheet
111 Westfall Road ● Rochester, NY 14620
IQ A-1 (2/20)
White-MCDPH Copy Yellow-Patient Copy
Voluntary Quarantine Agreement
To:
From:
RE: Voluntary Quarantine of _____________________________
(Person)
Date: _____________________
Pursuant to Public Health Law, the Monroe County Department of Public Health (MCDPH) and its Commissioner are
required to protect the public from the danger of communicable diseases.
It has been determined that you may have been exposed to a person with __________, a communicable disease that
has the potential to adversely affect your health and the health of the public. Therefore, MCDPH is requesting that you
quarantine yourself (not come into contact with others) to protect your health and the health of others.
You are requested to remain in quarantine at _____________________________ for _____ days after the date of your
exposure and to immediately notify MCDPH if you develop any symptoms outlined in the enclosed information packet.
MCDPH has determined that the date of exposure was ________ and you will be released from quarantine on or about
___________, provided you do not develop symptoms as noted in the information packet. We understand that this
may cause significant inconvenience to you; however, it is very important for the protection of your own health and that
of others that you abide by this request for quarantine. Please read this agreement carefully and follow the enclosed
recommendations.
You or your legal guardian may contact the following MCDPH representative to request assistance in complying, seek
relief from, clarification of, or further explanation of the conditions contained in any part of this agreement.
_________________________________________ (____)____-________
(Name of MCDPH contact person) (Daytime telephone #)
Failure to comply with this request may result in the issuance of a Health Director Order or a Court Order enforced by
MCDPH and/or law enforcement officials. Willful breach of a Court Order may be considered contempt of Court and
may result in criminal prosecution. In the event of a Health Director Order or Court Order, you are entitled to the
following forms of Due Process:
1. Right to adequate Notice (a written order)
2. Right to a hearing
3. Right to counsel (will be provided if indigent)
4. Right to appeal the final decision
I agree to a 911 premise warning which notifies emergency workers to contact MCDPH before entering this location.
The provisions of this agreement have been explained by the MCDPH representative and I fully understand that my
failure to follow these guidelines or to voluntarily remain in quarantine may result in placement in involuntary
quarantine or committed to a facility where I may be quarantined against my wishes.
________________________________ ___________________________ Date: _________________

________________________________ ___________________________ Date: ________________

(Print name of MCDPH representative) (Signature)
Enclosure: Quarantine Guidelines, Disease Information Sheet
IQ A-2 (2/20) White-MCDPH Copy Yellow-Patient Copy
Health Order of Isolation
TO: _________________________________
ADDRESS: _________________________________
SIR/MADAM:
Effective upon your receipt of this Health Order you are hereby directed by the Health Commissioner of the Monroe County
Department of Public Health (“Commissioner”) to be isolated at __________________________, due to the belief of the Monroe
County Department of Public Health (MCDPH) that you suffer from a communicable disease or a suspected case of a communicable
disease as defined in the New York State Sanitary Code §10 N.Y.C.R.R. 2.1.
You are ordered to remain at ____________________ by the authority vested in the Commissioner under the New York
State Public Health Law and regulations. MCDPH has been advised that you have a communicable condition called
_______________. The disease which you are suspected of having is highly contagious and may be fatal.
Except as described below, you may not leave __________________ without further order of the Commissioner or a Court
of proper jurisdiction. This Order will remain in effect until otherwise ordered by the Court; or until the Department of Public Health
has received notice that you are no longer contagious.
The Department of Public Health, or anyone else designated by the Commissioner, including law enforcement personnel,
are hereby authorized and directed to use all reasonable means necessary including physical force to enforce this Order, so as to
prevent harm to the general public occasioned by your failure to comply with voluntary isolation
At this time, should you wish to voluntarily comply with this Order, the Department of Public Health kindly requests that
you sign at the bottom of this document.
In the event that you do not wish to comply with this Order, please be advised that as soon as possible but not more than
five (5) days of service of this Health Order, you are isolated at ________________, the Department of Public Health shall submit by
affidavit and other supporting documents, an Order to Show Cause/Petition for a Court Order authorizing the initial or continued
isolation and an expedited hearing to continue said isolation on the grounds that you possess a health threat to yourself and to the
general public. Your detention shall not continue for more than 10 business days after the filing of the petition in the absence of the
scheduling of a hearing for a court order authorizing such isolation. Moreover, the Commissioner must obtain a Court Order
authorizing your continuing isolation.
Please be advised that you have a right to be represented by legal counsel or to have counsel provided, and that if you
qualify to have counsel provided, such counsel will be made available upon your request and the determination of the Court.
Moreover, you may supply to the Department of Public Health the addresses and/or telephone numbers of friends and/or relatives
to receive notification of your isolation. At your request, the Department of Public Health shall provide notice to a reasonable
number of such persons that you are being isolated. You have the right to appeal this Order pursuant to the New York State Civil
Procedure Law and Rules.
Dated: ________________ ___________________________________________

Michael D. Mendoza, MD, Commissioner of Public Health
I, ______________________, have read the above and had an opportunity to ask questions regarding the current Health
Order to my satisfaction. At this time, I agree to comply with the Order and do not wish to proceed to a Court proceeding.
However, I do understand in the event I fail to comply with this Order, the Department of Public Health may seek additional isolation
through the Courts. I further agree to comply with the Department of Public Health’s requests for information and
recommendations for monitoring and/or treatment.
Date: ____________ __________________________________ _________________________________


IQ A-3 (2/20) White – MCDPH Copy Yellow – Patient Copy
Health Order of Quarantine
TO: ___________________________________
ADDRESS: _________________________________
SIR/MADAM:
Effective upon your receipt of this Health Order you are hereby directed by the Health Commissioner of the Monroe County
Department of Public Health (“Commissioner”) to be quarantined at __________________________, due to the belief of the
Monroe County Department of Public Health that you have been exposed to a communicable disease as defined in the New York
State Sanitary Code §10 N.Y.C.R.R. 2.1.
You are ordered to remain at ____________________ by the authority vested in the Commissioner under the New York
State Public Health Law and regulations. The Department of Public Health has been advised that you meet the criteria for risk
and/or exposure to a communicable condition called ___________________.
Except as described below, you may not leave __________________ without further order of the Commissioner or a Court
of proper jurisdiction. This Order will remain in effect until otherwise ordered by the Court; or until the Department of Public Health
has received notice that you are no longer at risk.
The Department of Public Health, or anyone else designated by the Commissioner, including law enforcement personnel,
are hereby authorized and directed to use all reasonable means necessary including physical force to enforce this Order, so as to
prevent harm to the general public should you fail to comply with voluntary quarantine.
At this time, should you wish to voluntarily comply with this Order, the Department of Public Health kindly requests that
you sign at the bottom of this document.
In the event that you do not wish to comply with this Order, please be advised that as soon as possible but not more than
five (5) days of service of this Health order, you are quarantined at ________________, the Department of Public Health shall submit
by affidavit and other supporting documents, an Order to Show Cause/Petition for a Court Order authorizing the initial or continued
quarantine and an expedited hearing to continue said quarantine on the grounds that you possess a health threat to yourself and to
the general public. Your detention shall not continue for more than 10 business days after the filing of the petition in the absence of
the scheduling of a hearing for a Court Order authorizing such quarantine. Moreover, the Commissioner must obtain a Court Order
authorizing your continuing quarantine.
Please be advised that you have a right to be represented by legal counsel or to have counsel provided, and that if you
qualify to have counsel provided, such counsel will be made available upon your request and the determination of the Court.
Moreover, you may supply to the Department of Public Health the addresses and/or telephone numbers of friends and/or relatives
to receive notification of your quarantine. At your request, the Department of Public Health shall provide notice to a reasonable
number of such persons that you are being quarantined. You have the right to appeal this Order pursuant to the New York State
Civil Procedure Law and Rules.
Date: ______________ __________________________________________

Michael D. Mendoza, MD, Commissioner of Public Health
I, ______________________, have read the above and had an opportunity to ask questions regarding the current Order to
my satisfaction. At this time, I agree to comply with the Health Order and do not wish to proceed to a court proceeding. However, I
do understand in the event I fail to comply with this Order, the Department of Public Health may seek additional quarantine through
the Courts. I further agree to comply with the Department of Public Health’s requests for information and recommendations for
monitoring and/or treatment.
Date: ____________ __________________________________ _________________________________


IQ A-4 (2/20) White – MCDPH Copy Yellow – Patient Copy
VERIFICATION
STATE OF NEW YORK )

) ss.:
COUNTY OF MONROE )
Michael D. Mendoza, M.D., being duly sworn, deposes and says that he is the Health
Commissioner of the Monroe County Department of Public Health, the Petitioner in the within entitled
proceeding. That he has read the foregoing petition and knows the contents thereof. That the same is
true to his knowledge, except as to the matters therein stated to be alleged upon information and belief,
and as to those matters he believes them to be true.
________________________________
Michael D. Mendoza, MD, MPH, MS
Sworn to before me this

___ day of __________, 20__
____________________________
Notary Public
IQ A-5 (2/20)
Sample Request for Judicial Intervention
IQ A-6 (2/20)
IQ A-6 (2/20)
Sample Order to Show Cause & to Schedule an Expedited Hearing
At an Ex Parte part of the Supreme Court of the State of New York,
in the County of Monroe, at the Hall of Justice, Rochester, New
York, on the ____ day of ____________
Present: Hon. __________________
Justice of Supreme Court
SUPREME COURT
COUNTY OF MONROE STATE OF NEW YORK
_____________________________________________
IN THE MATTER OF THE APPLICATION OF MONROE
COUNTY DEPARTMENT OF PUBLIC HEALTH,
Petitioner,
ORDER TO SHOW CAUSE
For an ORDER of Isolation/Quarantine Against
_________________________, Index No. _____________
Respondent.
_____________________________________________
STATE OF NEW YORK)
COUNTY OF MONROE) ss.
Upon reading and filing the annexed Petition of Neha S. Stowe, Esq., dated _____________; the Affidavit of
Michael D. Mendoza, M.D., dated _____________; together with the exhibits annexed thereto;
Let the Respondent show cause before the Honorable _____________________ at a Special Term of the
Supreme Court to be held in and for the County of Monroe at the Hall of Justice, 99 Exchange Boulevard, in the City of Rochester,
New York 14614 on the ____ day of _____, 20__ at ____ o’clock or as soon thereafter as the parties may be heard, why an Order
should not be made authorizing the continued isolation/quarantine of the Respondent at _______________ in accordance with
the order of the Commissioner of Monroe County Department of Public Health dated _______________________;
Now, it is hereby Ordered that the Order of the Health Commissioner of the Monroe County Department of
Public Health, dated _____________, which directed the isolation/quarantine of the Respondent herein, who is alleged to
___________________________________, shall remain in effect pending further order of this Court, and the Respondent shall
remain in isolation at ____________________ pending an expedited hearing on the merits of the petition; and
An expedited hearing on the merits of the petition shall be held on _____________________________; and
Sufficient cause appearing therefor, let personal service of a copy of this Order to Show Cause, together with
copies of the papers upon which it is based, upon the Respondent, on or before the ___ day of _____, 20 be deemed good and
sufficient service; and
The Respondent shall serve any answering affidavits on or before _____________. The Respondent shall
comply with the service requirements of the CPLR §2103(b).
Enter:
Justice of the Supreme Court
IQ A-7 (2/20)
SAMPLE Petition to the Court - Isolation
SUPREME COURT
____________________________________________
IN THE MATTER OF THE APPLICATION OF

MONROE COUNTY DEPARTMENT OF PUBLIC
HEALTH,
Petitioner,
PETITION
For an ORDER of Isolation Against ______________,
A person Alleged to be Afflicted with Index No.
____________,
Respondent.
_____________________________________________
STATE OF NEW YORK)

Petitioner, MONROE COUNTY DEPARTMENT OF PUBLIC HEALTH, through the County of Monroe
(“Petitioner”), by its counsel, Michael Davis, Monroe County Attorney, and Neha S. Stowe, Deputy County Attorney, respectfully
alleges:
1. That Neha S. Stowe is an attorney duly licensed to practice in the State of New York, is employed by the
County of Monroe and is counsel to the Monroe County Department of Public Health (“Health Department”).
2. That ___________ (“Respondent”) has been examined, evaluated and treated by Drs. _______________,
M.D., _____________, M.D., and ____________, M.D. and health professionals at the Health Department, and that Respondent
has been diagnosed as suffering from ____________, a designated communicable disease under 10 N.Y.C.R.R. 2.1.
3. That Michael D. Mendoza, M.D., Health Commissioner of the Health Department (“Commissioner”) has
investigated Respondent’s ____________ affliction, and on ____________ determined that Respondent posed an immediate
threat to the public health due to:
a. ___________ disease is highly contagious; and
b. Since Respondent’s __________ disease is in a contagious stage, isolation of Respondent is necessary
to prevent the spread of the disease to others.
c. _________________________ (other specific details as necessary).
I & Q A-8 (2/20)

4. This application and Order to Show Cause is intended: (a) to request an expedited hearing in order to
determine whether to continue in effect the order of the Commissioner of Health Department dated ____________ (“the
Health Order”), which directed the isolation of the Respondent as a result of his active __________, and (b) order that the
Respondent remain in isolation at ______________, a medical facility pending the hearing and determination of the application.
5. Petitioner seeks enforcement of the Health Order, which directed the isolation of the Respondent pursuant
to Public Health Law Section 2100 and 10 N.Y.C.R.R. 2.29.
6. Based upon Respondent’s behavior and statements to the Commissioner, Petitioner concludes that there is a
substantial likelihood that Respondent cannot be relied upon to comply with voluntary isolation, and to follow required
contagion precautions for ____________.
7. As a result of Respondent’s non-compliance with voluntary isolation and contagion precautions, there is no
appropriate less restrictive alternative than __________ facility at the present time.
8. The Respondent has been isolated at ______________ facility under the Health Order since approximately
________ on __________, 20__.
9. Petitioner seeks to continue the isolation of the Respondent only until the Health Department or the Court
determines that Respondent’s condition has changed such that the Respondent’s ___________ is no longer contagious.
10. The Health Order requires that the Commissioner of the Health Department submit an application for a court
order within five (5) days after service of the Health Order, which seeks to authorize the initial or continued isolation on the
grounds that the person poses a health threat to himself or to the public health.
11. Based upon the information contained herein, Petitioner believes that the release of the Respondent from
isolation at this time would pose a threat to Respondent and the public health.
12. Petitioner requests that this application for ex parte relief be presented promptly to a Justice of this Court for
immediate consideration and on an expedited basis.
13. No previous application has been made for the relief sought herein.
WHEREFORE, Petitioner prays:
1. That the annexed Order to Show Cause be signed by this Court.
I & Q A-8 (2/20)

2. That an Order of the Court be granted to permit the continued isolation of the Respondent at
______________________facility in accordance with the Health Order dated _____________.
3. That a hearing on the merits of continued isolation be scheduled on an expedited basis, at the earliest date
convenient for the Court;
4. And for such other and further relief as may be just, proper and equitable.
Dated: _____________
Rochester, New York
Neha S. Stowe, Esq., of Counsel

Deputy County Attorney
Michael Davis, County Attorney
Attorney for Monroe County
307 County Office Building
Rochester, NY 14614
(585) 753-1492
I & Q A-8 (2/20)

SAMPLE Petition to the Court - Quarantine
SUPREME COURT
____________________________________________
IN THE MATTER OF THE APPLICATION OF

MONROE COUNTY DEPARTMENT OF PUBLIC
HEALTH,
Petitioner,
PETITION
For an ORDER of Quarantine Against ______________,
A person Alleged to be Exposed to Index No.
____________,
Respondent.
_____________________________________________
STATE OF NEW YORK)

Petitioner, MONROE COUNTY DEPARTMENT OF PUBLIC HEALTH, through the County of Monroe
(“Petitioner”), by its counsel, Michael Davis, Monroe County Attorney, and Neha S. Stowe, Deputy County Attorney,
respectfully alleges:
1. That Neha S. Stowe is an attorney duly licensed to practice in the State of New York, is employed by the
County of Monroe and is counsel to the Monroe County Department of Public Health (“Health Department”).
2. That ___________ (“Respondent”) has been determined to be a contact of a suspect or probable case of
_______________________, a designated communicable disease under 10 N.Y.C.R.R. 2.1 by ____________, M.D. and
health professionals at the Health Department.
3. That Michael D. Mendoza, M.D., Health Commissioner of the Health Department (“Commissioner”) has
investigated Respondent’s ____________exposure, and on ____________ determined that Respondent posed an
immediate threat to the public health due to:
a. ___________ disease is highly contagious; and
b. Since Respondent’s __________ exposure to the disease could potentially infect others,
quarantine of Respondent is necessary to prevent the spread of the disease to others.
c. _________________________ (other specific details as necessary).
IQ A-9 (2/20)
4. This application and Order to Show Cause is intended: (a) to request an expedited hearing in order to
determine whether to continue in effect the Order of the Commissioner of Health Department dated ____________ (“the
Health Order”), which directed the quarantine of the Respondent as a result of his exposure to __________, and (b) order
that the Respondent remain in quarantine at ______________, pending the hearing and determination of the application.
5. Petitioner seeks enforcement of the Health Order, which directed the quarantine of the Respondent
pursuant to Public Health Law Section 2100 and 10 N.Y.C.R.R. 2.29.
6. Based upon Respondent’s behavior and statements to the Commissioner, Petitioner concludes that there
is a substantial likelihood that Respondent cannot be relied upon to comply with voluntary quarantine for ____________.
7. As a result of Respondent’s non-compliance with voluntary quarantine, there is no appropriate less
restrictive alternative than __________ facility at the present time.
8. The Respondent has been quarantine at ______________ facility under the Health Order since
approximately ________ on __________, 20__.
9. Petitioner seeks to continue the quarantine of the Respondent only until the Health Department or the
Court determines that Respondent’s incubation period of this communicable disease has passed such that the
Respondent’s ___________ is no longer potentially contagious.
10. The Health Order requires that the Commissioner of the Health Department submit an application for a
Court Order within five (5) days after service of the Health Order, which seeks to authorize the initial or continued
quarantine on the grounds that the person poses a health threat to himself or to the public health.
11. Based upon the information contained herein, Petitioner believes that the release of the Respondent
from quarantine at this time would pose a threat to Respondent and the public health.
12. Petitioner requests that this application for ex parte relief be presented promptly to a Justice of this
Court for immediate consideration and on an expedited basis.
13. No previous application has been made for the relief sought herein.
WHEREFORE, Petitioner prays:
That the annexed Order to Show Cause be signed by this Court.
IQ A-9 (2/20)
1. That an Order of the Court be granted to permit the continued quarantine of the Respondent at
______________________facility in accordance with the Director’s Order dated _____________.
2. That a hearing on the merits of continued quarantine be scheduled on an expedited basis, at the earliest
date convenient for the Court;
3. And for such other and further relief as may be just, proper and equitable.
Dated: _____________
Rochester, New York
Neha S. Stowe, Esq., of Counsel

Deputy County Attorney
Michael Davis, County Attorney
Attorney for Monroe County
307 County Office Building
Rochester, NY 14614
(585) 753-1492
IQ A-9 (2/20)
SAMPLE Affidavit in Support of the Petition - Isolation

___________________________________________
IN THE MATTER OF THE APPLICATION OF THE

MONROE COUNTY HEALTH DEPARTMENT
Petitioner,
For an Order of Isolation Against ______________, AFFIDAVIT

A Person Alleged to be Afflicted with ____________
Index No.
Respondent.
___________________________________________
STATE OF NEW YORK )

COUNTY OF MONROE ) ss:
Michael D. Mendoza, M.D., being duly sworn, deposes and says:
1. I am a physician and duly licensed to practice medicine in the State of New York, and am the Health
Commissioner of the Monroe County Public Health Department in Rochester, New York (“Health Department”).
2. I submit this Affidavit in support of the petition of the Health Department directing that my order, dated
____________ (“Health Order,” a copy of which is attached hereto as Exhibit “A”) directing the isolation of the
Respondent herein, who suffers___________________, remain in effect; and ordering that the Respondent remain in
isolation pending the hearing on the merits of the petition.
Background Information on
3. ____________ is a designated communicable disease under 10 N.Y.C.R.R. 2.1 which may be transmitted
when the organism which causes ___________ is ________________________.
4. ___________ disease is highly contagious because _______________.
5. ___________ means that the organisms have _______________. This condition exists when
______________________.
6. ______________ disease occurs when the body __________________.
7. Public health measures directed at controlling the spread of ___________ require that while the infected
individual is contagious, he/she be separated from other persons to the greatest extent possible to prevent the
transmission of the disease to the general public.
8. Since individuals who are infectious generally have symptoms that make them feel ill, admission to a
hospital or health care facility for treatment and implementation of contingent control precautions is often
recommended by the Monroe County Department of Health and other public health professionals.
9. Where there is substantial likelihood, based on the person’s past and present behavior, that he/she cannot
be relied upon to comply with voluntary isolation, or participate in, or complete an appropriate prescribed course of
IQ A-10 (2/20)
medication for ___________, public health protocols require that the individual with ________ be isolated in a hospital
or other facility.
Respondent
10. The Respondent was seen by Dr. ____________________, M.D. and Dr. ________________ M.D., and based
on Respondent’s symptoms of ______________, ________________ and _______________, and the results of these
tests, they diagnosed Respondent as having ______________.
11. On ___________, Respondent was counseled regarding the dangers associated with his illness, the
importance of taking medication if prescribed and the risks posed to his friends and the general public and the
importance of complying with the request for separation from family and the general public. Although the Health
Department put forth substantial efforts to find a safe, separate living environment, in order for Respondent to
complete the treatment and maintain isolation, Respondent declined each offer for such assistance.
12. On _______, Respondent was seen by _______________, M.D., who advised Respondent as to the
importance of complying with his medications if prescribed. Although Respondent stated that he understood Dr.
_________’s advice, Respondent has demonstrated his/her unwillingness to begin treatment by
________________________.
13. Respondent has demonstrated a significant unwillingness or inability to remain compliant with less
restrictive treatment methods despite several attempts by the Health Department and his physicians to assist in doing
so. Consequently, at present, in my professional medical opinion, Respondent poses an immediate and serious threat to
himself and the public health.
14. In view of the Respondent’s failure to voluntarily comply with the request for isolation and to follow a
prescribed course of treatment, I determined that the prudent course would be to exercise my authority as Health
Commissioner under Public Health Law §2100 and 10 N.Y.C.R.R. 2.29, and order that the Respondent be detained at
______________ facility for isolation.
15. The opinions rendered herein are based upon my review of the medical records which are attached hereto,
the report prepared by ____________________ for the Health Department (a copy of which is attached as Exhibit “B”),
and discussions with Respondent’s physicians.
16. Based upon my review of Respondent’s medical file and discussions with his physicians and Health
Department clinic representatives, I recommend that Respondent be isolated at __________ facility pending receipt of a
report that Respondent is no longer infectious.
______________________________
Michael D. Mendoza, M.D.
Sworn to before me this _____

day of ______________, 20__
__________________________
Notary Public
IQ A-10 (2/20)
SAMPLE Affidavit in Support of the Petition - Quarantine

___________________________________________
IN THE MATTER OF THE APPLICATION OF THE
MONROE COUNTY HEALTH DEPARTMENT
Petitioner,
For an Order of Quarantine Against ______________, AFFIDAVIT

A Person Alleged to be Exposed to ____________
Index No.
Respondent.
___________________________________________
STATE OF NEW YORK )

COUNTY OF MONROE ) ss:
Michael D. Mendoza, M.D., being duly sworn, deposes and says:
1. I am a physician and duly licensed to practice medicine in the State of New York, and am the
Health Commissioner of the Monroe County Public Health Department in Rochester, New York (“Health
Department”).
2. I submit this Affidavit in support of the petition of the Health Department directing that my
order, dated ____________ (“Health Order,” a copy of which is attached hereto as Exhibit “A”) directing the
quarantine of the Respondent herein, who was exposed to ___________________, remain in effect; and
ordering that the Respondent remain in quarantine pending the hearing on the merits of the petition.
Background Information on
3. ____________ is a designated communicable disease under 10 N.Y.C.R.R. 2.1 which may be

transmitted when the organism which causes ___________ is ________________________.
4. ___________ disease is highly contagious because _______________.
5. ___________ means that the organisms have _______________. This condition exists
when ______________________.
6. ______________ disease occurs when the body __________________.
7. Public health measures directed at controlling the spread of ___________ require that the
exposed individual be separated from other persons to the greatest extent possible during the incubation
period of the disease to prevent the transmission of the disease to the general public.
IQ A-11 (2/20)
8. Where there is substantial likelihood, based on the person’s past and present behavior that
he/she cannot be relied upon to comply with voluntary quarantine public health protocols require that the
individual with exposure to ________ be quarantined in a pre-identified facility.
Respondent
9. The Respondent was determined to have been a contact of a suspect or probable case of
________________, a communicable disease dangerous to the public health to _________________ by
____________, M.D.
10. On ___________, Respondent was counseled regarding the dangers associated with exposure
to this illness, and the risks posed to his friends and the general public and the importance of complying with
the request for separation from family and the general public. Although the Health Department put forth
substantial efforts to find a safe, separate living environment, in order for Respondent to maintain
quarantine, Respondent declined each offer for such assistance.
11. Respondent has demonstrated a significant unwillingness or inability to remain compliant

with less restrictive treatment methods despite several attempts by the Health Department and his
physicians to assist in doing so. Consequently, at present, in my professional medical opinion, Respondent
poses an immediate and serious threat to himself and the public health.
12. In view of the Respondent’s failure to voluntarily comply with the request for quarantine, I
determined that the prudent course would be to exercise my authority as Health Commissioner under Public
Health Law §2100 and 10 N.Y.C.R.R. 2.29, and order that the Respondent be detained at ______________
facility for quarantine.
13. The opinions rendered herein are based upon my review of the medical records which are
attached hereto, the report prepared by ____________________ for the Health Department (a copy of
which is attached as Exhibit “B”), and discussions with Respondent’s physicians.
14. Based upon my review of Respondent’s medical file and discussions with his physicians and
Health Department clinic representatives, I recommend that Respondent be quarantine at __________
facility pending receipt of a report that Respondent is no longer infectious.
______________________________
Michael D. Mendoza, M.D.
Sworn to before me this _____
day of ______________, 20__
__________________________
Notary Public
IQ A-11 (2/20)
SAMPLE Order for Continuing Isolation or Quarantine
At a Special Term of the Supreme Court of the State of New

York, County of Monroe, held at the Hall of Justice,
Rochester, New York, on the ____ day of _______________
Present: Hon. ________________
Supreme Court Justice
SUPREME COURT
_____________________________________________
IN THE MATTER OF THE APPLICATION OF MONROE

COUNTY DEPARTMENT OF PUBLIC HEALTH,
Petitioner,
ORDER
For an ORDER of Isolation/Quarantine Against
______________________, Index No. ________
Respondent.
_____________________________________________
STATE OF NEW YORK)

Upon reading and filing the Petition of the Monroe County Department of Public Health, through the
County of Monroe by its counsel, Neha S. Stowe, Esq., dated ____________; and the Affidavit of Michael D. Mendoza M.D., Health
Commissioner of the Monroe County Department of Public Health, dated ______________; and the Respondent having appeared
____________________(insert name of counsel and pro se), and a hearing having been held before the undersigned and
testimony having been given therein by Michael D. Mendoza, M.D. and the Respondent,
Now, pursuant to the Order to Show Cause brought by the Monroe County Department of Public
Health, through the County of Monroe,
It is hereby Ordered and adjudged:
1. That Respondent shall remain in isolation/quarantine at ___________________ determined by
the Commissioner of the Monroe County Health Department for a period of _____________________, or until further Order of
this Court; and
2. ______________________
The Honorable _______________

Justice of the Supreme Court
IQ A-12 (2/20)
Appendix B CONTACT INFORMATION
KEY PERSONNEL - CONTACT NAMES AND PHONE NUMBERS
TITLE NAME PHONE NUMBER EMAIL ADDRESS

Monroe County Executive Adam J. Bello 585-753-1645 adambello@monroecounty.gov
Monroe County Department Michael Mendoza, 585-753-2989 Office michaelmendoza@monroecounty.gov

of Health Commissioner M.D. 585-478-8980 Cell
585-529-0906 Pager
Monroe County Attorney Neha Stowe 585-753-1492 Office nstowe@monroecounty.gov
(MCDPH Contact)
Supreme Court Judges, Hon. Craig J. Doran, 585-412-5292 Office cdoran@nycourts.gov
Seventh Judicial District Chief Administrative 585-412-5328 Fax
Judge, Seventh 585-261-2864 Cell
Judicial District
Hon. Kenneth Fischer 585-371-3753

Hon. Ann Marie 585-371-3753
Taddeo
Law Clerk for Judge Doran Jackie Sisson 585-412-5290 Office
585-412-5328 Fax
585-402-2626 Cell
Monroe County Sheriff 585-753-4713
Liaison
Monroe County Sheriff Major Lou Tomassetti 585-428-2320 ltomassetti@monroecounty.gov
Office
Law Enforcement Agencies 911
Probation Services Larry Mattle 585-753-3226 lmattle@monroecounty.gov
Office
585-370-6764 Cell
EMS Transport Tim Czapranski 585-753-3760 tczapranski@monroecounty.gov
Monroe County Safety and Pete Mikiciuk 585-753-3012 petermikiciuk@monroecounty.gov

Security Administrator Office
(24/7) 329-9768 Cell
Monroe Community Colleen Rose 585-760-6500 colleenrose@monroehosp.org
Hospital
IQ B (02/20)
MCDPH CONTACT NAMES AND PHONE NUMBERS
DIVISION NAME PHONE NUMBER EMAIL ADDRESS
Office of Public Health Mike Sayers 585-753-5129 msayers@monroecounty.gov

Preparedness
Nursing Services Kathy Hiltunen 585-753-5123 kathyhiltunen@monroecounty.gov
Epidemiology/Disease Heather Essig 585-753-5166 heatheressig@monroecounty.gov

Control
Environmental Health Wade Silkworth 585-753-5470 wadesilkworth@monroecounty.gov
HOSPITAL CONTACT NAMES AND PHONE NUMBERS*
*For updated Hospital Points of Contact – refer to ESF – 8 Hospital Points of Contact on WebEOC. This will ensure
the most up to date contact information.
IQ B (02/20)
Appendix C ALTERNATE SITES TO HOLD HEARINGS
LOCATION PROCESS STAFF NEEDED
Monroe Community Hospital Use of video-conference Appropriate level of MCDPH staff

435 East Henrietta Rd. with patient.
Rochester, NY 14620 Security staff if needed.
585-760-6500 Health Commissioner or County
Attorney with judge at court site
Monroe County Department of Use of video-conference Same as above
Public Health
111 Westfall Road
Rochester, NY 14620
585-753-5023
Hospital Isolation Room Use of video-conference Same as above
Patient’s Home Use of video-conference Same as above
IQ C (2/20)
Appendix D ALTERNATE ISOLATION AND QUARANTINE SITES
1. Considerations for Facilities for Isolation:

Separate rooms for patients or areas amenable to isolation of patients, separate air handling for
each room or isolation area, ability to modify as needed to meet AIIR standards, ability to control
access to facility and each room, available potable water, bathroom and shower facilities, space
for patient evaluation, treatment and monitoring, ability to disinfect rooms and corridors,
accommodations for staff, easy access for delivery of medical supplies, food, other supplies,
dependable telephone system, provision for social diversion (TV, radio, etc.)
Possible Isolation Site Site Investigation Site MOU/LOA Security
Status/Additional Information Capacity Staff
Community health centers
Surgical Centers
Existing nursing home Would need to move current Mutual
patients using mutual aid plan aid plan
Wing of Monroe Community MCH would have to move
Hospital current patients to another
facility.
Most rooms are semis with
shared bathrooms
College dormitories
Local hotels/motels See attached listing.
American Red Cross Shelter Sites Information available on these
sites: Many in schools
2. Considerations for facilities for quarantine:

Basic utilities, separate rooms and bathrooms for each contact, a functioning telephone system,
handicap accessible, office/staff areas, availability of food services and supplies, social support
(TV, radio, etc.)
Possible Quarantine Site Site Investigation Site MOU/LOA Security
Status/Additional Information Capacity Staff
Nursing Home Use of mutual aid plan to move Mutual aid
current patients plan
Wing of MCH Need to move current patients.
Most rooms are semis with
shared bathrooms
Local Hotels/Motels See attached listing.
College dormitories Shared bathrooms
American Red Cross Shelter Sites Information available on these
sites: Many in schools
MCDPH POD Sites Inventory for POD Sites under
way.
IQ D (2/20)
Isolation and Quarantine Record (Form E)
Date/Time Record Started: Case ID Number:
Case/Contact Information
Patient Name: (Last) (First, MI)
DOB: / / Sex: ☐ Male ☐ Female
Home Address: City: Zip Code:
Home Phone: ( ) - Work: ( ) - Cell: ( ) -
E-mail Address
Current Location:
Primary Language: Translator Name:
Employment:
Employer Address: City: State:
Supervisor:
Medical Conditions:
Medications:
Initial Signs and Symptoms Date of Onset
Lab/X-ray Results Date
Diagnosis: Diagnosed by: Phone: ( )

Treatment Initiated: Date:
OR Treatment/Immunization Refused
Primary Physician: Phone: ( ) -
Public Health Consultation

Home Quarantine Assessment done: ☐ Yes ☐ No
Home Isolation Assessment done: ☐ Yes ☐ No
Commissioner Informed: ☐ Yes ☐ No Date: Time:
☐ Isolation Recommended Date: Time:
☐ Quarantine Recommended Date: Time:
Discussed with Patient:

☐ Described infection (signs, symptoms, laboratory results) and/or exposure
☐ Described reasons for quarantine or isolation
IQ E (2/20)
☐ Reviewed obstacles of quarantine or isolation
☐ Other:
☐ Patient informed of when to contact MCDPH and given contact name and number
Completed by: Phone: Date:
Voluntary Quarantine (if applicable)

Voluntary quarantine requested: ☐ Yes ☐ No Date: Time:
Voluntary quarantine duration: days End Date: End Time:
MCDPH Case Manager Assigned:
Additional Recommendations:
Location of Quarantine: ☐ Home ☐ Other Residence ☐ Facility

Address of quarantine location:
Phone:
Patient agrees to comply with quarantine: ☐ Yes ☐ No Initials:
Patient provided written notice of disease, request for Voluntary Quarantine Agreement and
consequences of non-compliance: ☐ Yes ☐ No Initials:
Patient signed Voluntary Quarantine Agreement: ☐ Yes ☐ No Initials:
Completed by: Date:
Voluntary Isolation (if applicable)

Voluntary isolation requested: ☐ Yes ☐ No Date: Time:
Voluntary isolation duration: days End Date: End Time:
MCDPH Case Manager Assigned:
Location of Isolation: ☐ Home ☐ Other Residence ☐ Facility

Address of isolation location:
Phone:
Patient agrees to comply with isolation: ☐ Yes ☐ No Initials:
Patient provided written notice of disease, request for Voluntary Isolation Agreement and
consequences of non-compliance: ☐ Yes ☐ No Initials:
Patient signed Voluntary Isolation Agreement: ☐ Yes ☐ No Initials:
Completed by: Date:
Documentation of Non-Compliance (see Isolation and Quarantine Contact Log) ☐ Yes ☐ No
IQ E (2/20)
Involuntary Quarantine – Health Order
Involuntary quarantine ordered: ☐ Yes ☐ No Date: Time:
Involuntary quarantine duration: days End Date: End Time:
Served by:
MCDPH Representative:
Location of quarantine: ☐ Home ☐ Other Residence ☐ Facility

Address of location of quarantine:
Telephone: ( ) -
Patient agrees to comply with Health Order: ☐ Yes ☐ No Initials:
Patient provided written notice of disease, Health Order, and consequences of non-compliance:
☐ Yes ☐ No Initials:
Patient signed Involuntary Quarantine Health Order: ☐ Yes ☐ No Initials::
Completed by: Date:
Involuntary Isolation – Health Order

Involuntary isolation ordered: ☐ Yes ☐ No Date: Time:
Involuntary isolation duration: days End Date: End Time:
Served by:
Location of isolation: ☐ Home ☐ Other Residence ☐ Facility

Address of location of isolation:
Telephone: ( ) -
Patient agrees to comply with Health Order: ☐ Yes ☐ No Initials:
Patient provided written notice of disease, Health Order, and consequences of non-compliance:
☐ Yes ☐ No Initials:
Patient signed Involuntary Isolation Health Order: ☐ Yes ☐ No Initials::
Completed by: Date:
Involuntary Quarantine – Court Order

County Attorney notified: ☐ Yes ☐ No Date: Time:
Attorney Name: Phone:
Compliance documentation record, medical records including lab reports and physician
affidavits if necessary given to County Attorney: ☐ Yes ☐ No Date: Time:
Court Documents completed: ☐ Yes ☐ No Date: Time:
Request for Judicial Intervention
Order to Show Cause
Petition for an Order of Quarantine
IQ E (2/20)
Affidavit in Support of the Petition
Order for Continuing Quarantine
Involuntary quarantine Date: Time:
ordered: ☐ Yes ☐ No
Involuntary quarantine duration: End Date: End Time:
days
Location of quarantine: ☐ Home ☐ Other Residence ☐ Facility

Address of location of quarantine:
Telephone: ( ) -
Patient provided written notice of disease, request for compliance, and consequences of non-
compliance: ☐ Yes ☐ No Initials:
Completed by: Date:
Involuntary Isolation – Court Order

County Attorney notified: ☐ Yes ☐ No Date: Time:
Attorney Name: Phone:
Compliance documentation record, medical records including lab reports and physician
affidavits if necessary given to County Attorney: ☐ Yes ☐ No Date: Time:
Court Documents completed: Date: Time:
Request for Judicial Intervention
Order to Show Cause
Petition for an Order of Quarantine
Affidavit in Support of the Petition
Order for Continuing Quarantine
Involuntary isolation ordered: ☐ Yes ☐ No Date: Time:
Involuntary isolation duration: days End Date: End Time:
Location of isolation: ☐ Home ☐ Other Residence ☐ Facility

Address of location of isolation:
Telephone: ( ) -
Patient provided written notice of disease, request for compliance, and consequences of non-
compliance: ☐ Yes ☐ No Initials:
Completed by: Date:
IQ E (2/20)
Home or Facility Isolation/Quarantine Checklist
Date: ______/______/_________ Case ID#:______________________________

Case/Contact/Facility Name: ________________________________________________
Address:__________________________________________________________________
Patient Telephone Number (______) ______ - ____________
Primary Caregiver Name: Last______________________ First:______________________
Primary Caregiver Telephone Number: (______) ______ - ____________
Reviewer Name: Last _________________________First: ________________________
Type of Home/Facility
☐Single Family/Single Unit ☐Single Family/Multiple Unit ☐Single Family/Apartment
☐Community-Based Facility (describe) ______________________________________
☐Other (describe)________________________________________________________
Number of Occupants in home/facility____________________
Number of bedrooms ____________
Number of bathrooms ____________
Patient Information: Yes No

Does the case/contact speak English as their primary language? ☐ ☐
If no, what is their primary language __________________
If no, does the case/contact need an interpreter __________
Does the case/contact have a car? ☐ ☐
Is the case/contact currently employed? ☐ ☐
Employer _______________________________________
Job description/title ______________________________
Can the case/contact work from home? ☐ ☐
Does the case/contact have paid time off for I/Q period? ☐ ☐
Does case/contact have a medical condition requiring regular monitoring,
medications, or supplies (e.g. insulin dependent diabetes requiring needles,
syringes, glucose test strips; chronic pulmonary disease on home oxygen, ☐ ☐
dialysis, etc.)?
Describe:
IQ F (2/20)
Home/Facility Information: Yes No
Does the home/facility have the following:
Functioning telephone/cell phone ☐ ☐
Internet Access ☐ ☐
Television ☐ ☐
Electricity ☐ ☐
Potable Water ☐ ☐
Refrigerator ☐ ☐
Oven/Microwave Oven ☐ ☐
Heat ☐ ☐
Air Conditioning ☐ ☐
Waste and sewage disposal (septic or sewer line) ☐ ☐
Garbage collection ☐ ☐
Washer/dryer ☐ ☐
Laundry supplies ☐ ☐
Separate room and bathroom for each case/contact with a door ☐ ☐
Access for healthcare workers or ambulance personnel ☐ ☐
Support Yes No
Does individual live alone? ☐ ☐
Are there pets in the home? ☐ ☐
Does case/contact need prescriptions filled? ☐ ☐
Does case/contact normally require a caregiver? ☐ ☐
Name of Caregiver: Phone:
Does case/contact have someone to run errands? ☐ ☐
Name of person: Phone:
Is there an available household member/facility staff person to be the
primary caregiver (isolation) and/or monitor contacts at least daily for ☐ ☐
symptoms?
Is there access to mental health and other psychological support ☐ ☐
services?
Are there sufficient medical supplies (gloves, masks, hand hygiene, etc.)? ☐ ☐
Is there adequate security for those in the home or facility? ☐ ☐
Supplies Yes No
Is there a two day supply of:
Dishwashing soap ☐ ☐
Plastic garbage bags ☐ ☐
Laundry soap ☐ ☐
Household disinfectants for cleaning ☐ ☐
IQ F (2/20)
Household Contacts Yes No
Are there household members who cannot care for themselves? ☐ ☐
Children? ☐ ☐
List of current household contacts:
Name/Relationship Age Stay in Home At Risk Needs
Yes No
Do other occupants in home need to be relocated? ☐ ☐
Can other occupants be moved to another home/facility? ☐ ☐
Recommendation:
☐ Home isolation/quarantine
☐ Isolation/quarantine at alternate facility
Reason for not recommending Home I/Q:
Preferred alternate facility:
Disposition:
☐ Case/Contact agrees to adhere to isolation/quarantine recommendation
☐ Case/Contact refuses to adhere to isolation/quarantine recommendation
Additional Steps: Yes No

Did case/contact receive Isolation/Quarantine Packet? ☐ ☐
Did case/contact receive Voluntary Isolation or Quarantine Request? ☐ ☐
Did case/contact receive I/Q supplies (hand hygiene, mask, gloves, etc.)? ☐ ☐
Has Case Manager been assigned? ☐ ☐
Name: Phone Number:
Comments:
Signature of Reviewer: Date:
IQ F (2/20)
MCDPH DAILY MONITORING LOG
Name: ____________________ Date of Birth: ________ Phone Number: ________________
MORNING EVENING OTHER SYMPTOMS Follow Up by

DATE TEMP TEMP (Describe) (Name of Compliant
MCDPH Staff)
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
IQ G (2/20)
LOG OF OBSTACLES TO COMPLIANCE AND RESOURCE REFERRALS
Name: ______________________________ Case Number: _______________
Address: ____________________________ Phone Number: ______________

____________________________
Date Problem Referral to: Outcome Compliance Case

Manager
IQ H (2/20)
SUPPORT SERVICES/RESOURCES
OBSTACLES/ POSSIBLE RESOURCES/CONTACT
UNMET NEEDS INFORMATION SERVICES AVAILABLE CAPACITY
(Family and friends first option) (Case Manager will coordinate with
agencies)
Monroe County Department of Financial services
Financial Needs: Human Services (DHS) Self-care needs
Loss of income Office of Mental Health (OMH) Family member needs
Loss of employment 111 Westfall Road, Rochester, NY Transportation needs
Unable to pay bills 14620 Education needs
(utility, phone, etc.) 585-753-6047 Mental Health Needs
585-753-2615 Communication Needs
Self-care Needs: Coordinate with community
Meal preparation agencies
Shopping Office of Faith Based and Coordinate with local churches
Housekeeping Community Initiatives (OFBCI) Spiritual support
Banking 244 Plymouth Ave South Self-care needs
Laundry Rochester, NY 14608 Family member needs
Medications/medical 585-262-5633 Transportation needs
supplies/equipment (ex. 585-729-2295 (cell) Pet care
oxygen) Financial needs
Social Needs MCDPH Nursing Services Self-Care Needs
Supplies to monitor Wegmans Corporate Card
condition, such as American Red Cross (ARC) Financial needs Meals on
thermometer) 50 Prince Street Self-care needs Wheels
Rochester, NY 14607 Family member needs (MOW)
Family Member Needs 585-241-4400 (24/7 available) Mental Health needs 1700
Care of children or other clients
family member Salvation Army Financial needs
10 Franklin Street Self-care needs
Transportation Needs Rochester, NY 14604 Family member needs
Physician appointments 585-987-9500
Volunteers of America Financial needs
Education Needs
214 Lake Avenue Self-care needs
Pet Care Needs Rochester, NY 14608 Family member needs
585-647-1150
Communication Needs Monroe County Medical Society Medical Care/Referrals
Non-English speaking 1441 East Avenue
Deaf/Hard of Hearing Rochester, NY 14610
585-473-7573
IQ I (2/20)
Visually Impaired
Monroe County Office of Community Resources
Emergency Management
1190 Scottsville Road
Mental Health Needs
Rochester, NY 14624
Drug/alcohol addict
585-753-3810
Mistrust of authority
Depression
Stigma concerns RGE/Constellation Energy Electric and gas services
Fear due to 400 West Ave
misinformation Rochester, NY 14611
585-546-2700
Sign Language Connection Deaf/Hard of Hearing
2445 Winton Place Bldg E interpreters
Suite 210 (county contract)
Rochester, NY 14623
585-454-4220
Frontier Telephone Landline phones, video phone
180 S. Clinton Ave support
Rochester, NY 14646
585-777-1000
Humane Society/Lollypop Farm Pet care/veterinary services
99 Victor Road
Fairport, NY 14450
585-223-1330
Medical Reserve Corps Medical and support staff
MCDPH – Room 854
111 Westfall Road
Rochester, NY 14620
585-753-5129
IQ I (2/20)
APPENDIX J ENVIRONMENTAL DECONTAMINATION SERVICES
Company Name and Address Phone Number and Contact Person
Clean Harbors Environmental Services, Inc. 315-463-9901 (7:00 am to 5:00 pm)

14 Corporate Circle Coordinator: Tony Napoli
East Syracuse, NY 13057 General Manager: Ed Hatten
Project Manager: Greg Ernst
National 24 hour emergency number
1-800-645-8265
National Vacuum Corporation 585-235-0330
860 Maple Avenue Facilities Manager: Keith Chatley
Suite 200 Operations Manager: Tom McInerney
Rochester, NY 14611
SUN Environmental Corp 585-436-5660
230 McKee Road, Rochester, NY Vice President: Steve Rinker
National Response Corporation (NRC) 1-800-225-6750
Veolia North America Local Contact is Michelle Vinson, account
manager, Industrial Business, VEOLIA
NORTH AMERICA; tel: 716 604-0129
cell: 716-998-9581
360 Woodward Ave, Kenmore, NY 14217
michelle.vinson@veolia.com
www.veolianorthamerica.com
Clean radioactive/chemical/biological.
SERVPRO 1-800-SERVPRO 24 hours/365 days
The SERVPRO Franchise Professionals

provide cleanup and recovery services for
many biohazard situations to include
Bloodborne Pathogens. Professionals
remove and dispose of bodily fluids, tissue
and other potentially pathogenic
substances. and clean, disinfect and
deodorize the structure.
New York State Department of Pete Miller, Spills Engineer
Environmental Conservation (NYSDEC) 585-226-5434
NYSDEC Region 8 Office, Avon, NY General #: 585-226-2466
https://www.dec.ny.gov/about/617.html
IQ J (2/20)
Appendix K-i PATIENT INFORMATION PACKET
K-1……... MCDPH Contact Information Sheet

K-2……... Information on Specific Communicable Disease
K-3……... Isolation Safe Practice Guidelines
K-4……... Quarantine Safe Practice Guidelines
K-5……... Daily Temperature Log
IQ K TOC (2/20)
Contact Information
Please find below your important Monroe County Department of Public Health contact
information.
Please feel free to contact us at any time with questions of concerns. Our normal
business hours are 8:30 A.M. – 4:30 P.M. Monday through Friday. Our After Hours
phone number is listed below in case of an emergency.
The following staff are assigned to assist you:
Case Manager (Nurse) ______________________________ Office Phone __________________

Cell Phone ____________________
Email ________________________
Disease Control Unit Supervisor _______________________ Office Phone __________________

Cell Phone ____________________
Email ________________________
After Hours Supervisor ______________________________ Office Phone __________________

Cell Phone ____________________
Email ________________________
Disease Control Unit Reporting Line – 585-753-5164
White copy – MCDPH Yellow copy - Patient
IQ K-1 (2/20)
Patient Packet #2
Communicable Disease Specific Information Sheet
(Will be printed at time of event)
IQ K-2 (2/20)
Isolation Guidelines for Preventing Spread of a Communicable Disease
1. Stay at Home
• Do not leave your property during the isolation period for any reason except a medical emergency or a reason
authorized by the Health Department. This includes work, school, public areas such as grocery store, movie theater,
mall, house of worship, day care, etc.
• If you need something outside of the home, ask family, friends or neighbors who are not sick to get it and drop it off at
your door.
• Failure to follow these instructions will place the health of others at risk.
• Only persons authorized by the Health Department may enter your home during the period of isolation or quarantine.
Those that enter without prior authorization may be subject to isolation or quarantine themselves. Notify friends and
relatives that they should not visit your home until further notice.
• The Health Department will notify you when you no longer require isolation. If you have any questions, please ask your
Case Manager.
2. Safe Practices
• Use a separate bed and, if possible, a separate bedroom
• Wear a surgical mask when in the same room with non-infected persons. If you cannot wear a mask, others in the same
room will be asked to wear a surgical mask or respirator.
• If you are not masked, cover nose and mouth with a disposable tissue when coughing or sneezing.
• Household wastes, including surgical masks and disposable tissues soiled with respiratory secretions, blood, or other
body fluids should be disposed of as normal household waste.
• Wash hands with soap and water for at least 20 seconds after all contact with respiratory secretions from coughing,
sneezing, blood, and all other body fluids. Educate and encourage other members of the household to do the same.
• All members of the household must wear gloves on both hands when they have contact with your respiratory
secretions, blood, and other body fluids. Alcohol-based hygiene products may be substituted for hand washing with
soap and water after gloves are removed.
• Gloves should not be reused but be discarded immediately after removal.
• Eating and drinking utensils must be washed with hot water and a household dishwashing detergent.
• Environmental surfaces (countertops, tables, sinks, etc.) in the kitchen, bathroom and bedroom must be cleaned and
disinfected with a household disinfectant, such as household bleach or Lysol, while wearing gloves, at least daily and
when soiled with respiratory secretions, blood, and other body fluids.
• Bed linens, towels, and personal clothing should not be shared with other members of the household.
• Clothes and linens should be washed in hot soapy water.
3. Medical Care
• Call your healthcare provider if symptoms worsen. Also, please call your Health Department Case Manager.
• If you need to go to the doctor’s office, notify your Case Manager. Depending on the situation, a family member or
friend drive may be able you in a private car. Do not take public transportation. Please contact your doctor before you
visit and tell the doctor what you have been diagnosed with or exposed to. Wear a surgical mask on the way to the
office, go straight to the receptionist when you arrive so you can be put in a private room.
• If you are very sick and need an ambulance to go to the hospital, let the 911 operator know that you may have a
communicable disease and also let the ambulance crew know when they arrive. If possible, notify your Case Manager.
• Advise other members of your household who develop symptoms to call their primary care provider, clinic or
emergency room where they intend to seek care to alert the healthcare workers prior to seeking treatment.
4. Compliance
• Arrange or request the Health Department Case Manager to arrange for the delivery of necessary items to the home,
including but not limited to food, clothing, and supplies during the period of isolation.
• The Health Department will contact you on a daily basis to follow-up on your condition and compliance with these
instructions.
• Postpone all routine appointments, such as medical appointments, DSS, etc. Discuss this with the Case Manager.
________________________________ ______________________________ ______________

Patient Signature Case Manager Date
White copy – MCDPH Yellow copy - Patient

IQ K-3 (2/20)
Quarantine Guidelines for Preventing Spread of a Communicable Disease

1. Activities
• Limit activities and interaction with other persons living outside the home.
• Only if authorized by the Health Department, you may leave home to go to __________ (work/school/pharmacy, etc).
• Only if authorized to leave home, avoid close contact (within 3 feet) with others. This includes avoiding the use of
public transportation and confining self to office as much as possible at work.
• Do not go to public areas such as grocery store, movie theater, mall, house of worship, day care.
• Failure to follow these instructions will place the health of others at risk.
• Only persons authorized by the Health Department may enter your home during the period of isolation or quarantine.
Those that enter without prior authorization may be subject to isolation or quarantine themselves. Notify friends and
relatives that they should not visit your home until further notice.
• Arrange with family, friends, neighbors or request the Health Department Case Manager to arrange for the delivery of
necessary items to the home, including but not limited to food, clothing, and supplies during the period of quarantine if
not authorized to leave the quarantine location to obtain the items.
• Postpone all routine appointments, such as medical appointments, DSS, etc. Discuss this with the Case Manager.
• The Health Department will notify you when you no longer require quarantine. If you have any questions, please ask
your Case Manager.
2. Safe Practices
• Cover your nose and mouth with a disposable tissue when coughing or sneezing.
• Household wastes, including surgical masks and disposable tissues soiled with respiratory secretions, blood, or other
body fluids should be disposed of as normal household waste.
• Wash hands with soap and water for at least 20 seconds after all contact with respiratory secretions from coughing,
sneezing, blood, and all other body fluids. Educate and encourage other members of the household to do the same.
• Environmental surfaces (countertops, tables, sinks, etc.) in the kitchen, bathroom and bedroom must be cleaned and
disinfected with a household disinfectant, such as household bleach or Lysol, while wearing gloves, at least daily and
when soiled with respiratory secretions, blood, and other body fluids.
3. Medical Care/Compliance
• If requested by the Health Department, monitor your temperature as instructed and report results to the Health
Department Case manager.
• Call the Health Department Case Manager and your healthcare provider if symptoms develop.
• To prevent transmission, if you or a member of the household develops symptoms and need to visit the doctor, clinic
or emergency department, alert the Case Manager and the healthcare workers prior to seeking treatment and
immediately upon arrival.
• Arrange or request the Health Department Case Manager to arrange for the delivery of necessary items to the home,
including but not limited to food, clothing, and supplies during the period of isolation. Review with Case Manager any
needs or obstacles that may interfere with compliance.
• The Health Department will contact you on a daily basis to follow-up on your condition and compliance with these
instructions.
• If symptoms develop:
• Use a separate bed and, if possible, a separate bedroom.
• Wear a surgical mask when in the same room with non-infected persons. If you cannot wear a mask, others in the
same room will be asked to wear a surgical mask or respirator.
• Bed linens, towels and personal clothing should not be shared with other members of the household. Clothes and
linens will be washed in hot soapy water.
• All members of the household should wear gloves on both hands when they have contact with your respiratory
secretions, blood, and other body fluids. Alcohol-based hygiene products may be substituted for hand washing
with soap and water after gloves are removed.
• Gloves should not be reused and shall be discarded immediately after removal.
• Obtain or request the Health Department to supply surgical masks, gloves and other items necessary to prevent
the spread of the communicable disease.
________________________________ ______________________________ ______________

Patient Signature Case Manager Date
White copy – MCDPH Yellow copy – Patient
IQ K-4 (2/20)
Daily Symptom/Temperature Log
Name: ________________________________ Date of Birth: ______________
Since you may have been exposed to ______________________________ through contact with
someone who is ill with this disease, you need to monitor your temperature twice a day.
This should be done for ___________ following your exposure. The Health Department will
provide you with the exact dates.
You have been provided this chart, the recommended infection control precautions for patients
with ____________________ and a supply of _______________________.
The attached chart is to record your temperature daily and any symptoms should they occur:
• a fever greater than _________
• symptoms such as:
 __________________________________
 __________________________________
 __________________________________
Before you leave your home to seek medical attention, please

• Contact your Health Department Case Manager (see Contact Information Sheet) and
• Notify your health care provider
The Health Department will be contacting you daily to monitor your temperature and any
symptoms that develop. If you have any questions about monitoring for symptoms, please
contact:
________________________________ at __________________.
You may wish to enter your health care provider’s name and telephone below for easy
reference should you become ill.
Health Care Provider: _______________________________________________

Telephone Number: _________________________________________________
IQ K-5 (2/20)
Daily Symptom/Temperature Log
Name: _________________________________ Date of Birth: ________________________
Date Morning Evening Other Symptoms

Temperature Temperature (describe)
IQ K-5 (2/20)
Appendix L Communicable Diseases - 10 NYCRR 2.1
NEW YORK CODES, RULES AND REGULATIONS

TITLE 10. DEPARTMENT OF HEALTH CHAPTER I. STATE SANITARY CODE
PART 2. COMMUNICABLE DISEASES DESIGNATION OF CASES 10 NYCRR § 2.1 (2012)
§ 2.1 Communicable diseases designated: cases, suspected cases and certain carriers to be
reported to the State Department of Health
(a) When used in the Public Health Law and in this Chapter, the term infectious, contagious or
communicable disease, shall be held to include the following diseases and any other disease
which the commissioner, in the reasonable exercise of his or her medical judgment, determines
to be communicable, rapidly emergent or a significant threat to public health, provided that the
disease which is added to this list solely by the commissioner's authority shall remain on the list
only if confirmed by the Public Health Council at its next scheduled meeting:
Amebiasis section 2.2 of this Part)

Anthrax Influenza (laboratory-confirmed)
Arboviral infection Legionellosis
Babesiosis Listeriosis
Botulism Lyme disease
Brucellosis Lymphogranuloma venereum
Campylobacteriosis Malaria
Chancroid Measles
Chlamydia trachomatis infection Melioidosis
Cholera Meningitis
Cryptosporidiosis Aseptic
Cyclosporiasis Hemophilus
Diphtheria Meningococcal
E. coli 0157:H7 infections Other (specify type)
Ehrlichiosis Meningococcemia
Encephalitis Monkeypox
Giardiasis Mumps
Glanders Pertussis (whooping cough)
Gonococcal infection Plague
Group A Streptococcal invasive disease Poliomyelitis
Group B Streptococcal invasive disease Psittacosis
Hantavirus disease Q Fever
Hemolytic uremic syndrome Rabies
Hemophilus influenzae (invasive disease) Rocky Mountain spotted fever
Hepatitis (A; B; C) Rubella
Herpes infection in infants aged 60 days or Congenital rubella syndrome
younger (neonatal) Salmonellosis
Hospital-associated infections (as defined in Severe Acute Respiratory Syndrome (SARS)
IQ L (2/20)
Shigellosis Tuberculosis, current disease (specify site)
Smallpox Tularemia
Staphylococcal enterotoxin B poisoning Typhoid
Streptococcus pneumoniae invasive disease Vaccinia disease (as defined in section 2.2
Syphilis, specify stage of this Part)
Tetanus Viral hemorrhagic fever
Toxic Shock Syndrome Yersiniosis
Trichinosis
(b) Upon receipt of a report made pursuant to section 2.10, the city, county or district health
officer shall retain a copy in his record of the reports of such communicable diseases as the
State Commissioner of Health may direct, and shall retain these copies until their destruction is
authorized by the State Commissioner of Health, and shall forward a copy of all reports
immediately to the State Department of Health. In lieu of an individual report of each case, the
city, county or district health officer may, with the written consent of the State Commissioner
of Health, make such summarized reports as the commissioner may require.
(c) Any disease outbreak or unusual disease shall also be reported to the State Department of
Health as provided in subdivision (b) of this section. Unusual disease is defined as a newly
apparent or emerging disease or syndrome of uncertain etiology that a health care provider or
the State Commissioner of Health has reason to believe could possibly be caused by a
transmissible infectious agent or microbial toxin.
NYS PUBLIC HEALTH LAW SECTION 2100 COMMUNICABLE DISEASE; LOCAL BOARDS OF
HEALTH AND HEALTH OFFICERS; POWERS AND DUTIES
1. Every local board of health and every health officer shall guard against the introduction of
such communicable diseases as are designated in the sanitary code, by the exercise of proper
and vigilant medical inspection and control of all persons and things infected with or exposed to
such diseases.
2. Every local board of health and every health officer may:
(a) provide for care and isolation of cases of communicable disease in a hospital or elsewhere
when necessary for protection of the public health and,
(b) subject to the provisions of the sanitary code, prohibit and prevent all intercourse and
communication with or use of infected premises, places and things, and require, and if
necessary, provide the means for the thorough purification and cleansing of the same before
general intercourse with the same or use thereof shall be allowed.
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NEW YORK CONSOLIDATED LAWS, PUBLIC HEALTH LAW - PBH § 2120. COMMUNICABLE DISEASE; CONTROL
OF DANGEROUS AND CARELESS PATIENTS; COMMITMENT
1. Whenever a complaint is made by a physician to a health officer that any person is afflicted
with a communicable disease or is a carrier of typhoid fever, tuberculosis, diphtheria or other
communicable disease and is unable or unwilling to conduct himself and to live in such a
manner as not to expose members of his family or household or other persons with whom he
may be associated to danger of infection, the health officer shall forthwith investigate the
circumstances alleged.
2. If the health officer finds after investigation that a person so afflicted is a menace to others,
he shall make and file a complaint against such person with a magistrate, and on such
complaint the said person shall be brought before such magistrate.
3. The magistrate after due notice and a hearing, if satisfied that the complaint of the health
officer is well founded and that the afflicted person is a source of danger to others, may commit
the said person to any hospital or institution established for the care of persons suffering from
any such communicable disease or maintaining a room, ward or wards for such persons.
4. In making such commitment the magistrate shall make such order for payment for the care
and maintenance of the person committed as he may deem proper.
5. A person who is committed pursuant to the provisions of this section shall be deemed to be
committed until discharged in the manner authorized by section two thousand one hundred
twenty-three of this chapter.
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A Presidential Document by the Executive Office of the President on 08/06/2014
Executive Order 13674 of July 31, 2014
Revised List of Quarantinable Communicable Diseases

By the authority vested in me as President by the Constitution and the laws of the United
States of America, including section 264(b) of title 42, United States Code, it is hereby ordered
as follows:
Section 1. Amendment to Executive Order 13295. Based upon the recommendation of the
Secretary of Health and Human Services, in consultation with the Acting Surgeon General, and
for the purposes set forth in section 1 of Executive Order 13295 of April 4, 2003, as amended
by Executive Order 13375 of April 1, 2005, section 1 of Executive Order 13295 shall be further
amended by replacing subsection (b) with the following:
“(b) Severe acute respiratory syndromes, which are diseases that are associated with fever and
signs and symptoms of pneumonia or other respiratory illness, are capable of being transmitted
from person to person, and that either are causing, or have the potential to cause, a pandemic,
or, upon infection, are highly likely to cause mortality or serious morbidity if not properly
controlled. This subsection does not apply to influenza.”
Sec. 2. General Provisions. (a) Nothing in this order shall be construed to impair or otherwise
affect:
(i) the authority granted by law to an executive department, agency, or the head thereof; or
(ii) the functions of the Director of the Office of Management and Budget relating to budgetary,
administrative, or legislative proposals.
(b) This order is not intended to, and does not, create any right or benefit, substantive or
procedural, enforceable at law or in equity by any party against the United States, its
departments, agencies, or entities, its officers, employees, or agents, or any other person.
THE WHITE HOUSE, July 31, 2014. [FR Doc. 2014-18682 Filed 8-5-14; 8:45 am]
Billing code 3295-F4
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Appendix L Quarantinable Communicable Diseases
A Presidential Document by the Executive Office of the President on 04/09/2003
Executive Order 13295 of April 4, 2003
Revised List of Quarantinable Communicable Diseases

By the authority vested in me as President by the Constitution and the laws of the United
States of America, including section 361(b) of the Public Health Service Act (42 U.S.C. 264(b)), it
is hereby ordered as follows:
Section 1. Based upon the recommendation of the Secretary of Health and Human Services (the
“Secretary”), in consultation with the Surgeon General, and for the purpose of specifying
certain communicable diseases for regulations providing for the apprehension, detention, or
conditional release of individuals to prevent the introduction, transmission, or spread of
suspected communicable diseases, the following communicable diseases are hereby specified
pursuant to section 361(b) of the Public Health Service Act:
(a) Cholera; Diphtheria; infectious Tuberculosis; Plague; Smallpox; Yellow Fever; and Viral
Hemorrhagic Fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American, and others not
yet isolated or named).
(b) Severe Acute Respiratory Syndrome (SARS), which is a disease associated with fever and
signs and symptoms of pneumonia or other respiratory illness, is transmitted from person to
person predominantly by the aerosolized or droplet route, and, if spread in the population,
would have severe public health consequences.
Sec. 2. The Secretary, in the Secretary's discretion, shall determine whether a particular
condition constitutes a communicable disease of the type specified in section 1 of this order.
Sec. 3. The functions of the President under sections 362 and 364(a) of the Public Health
Service Act (42 U.S.C. 265 and 267(a)) are assigned to the Secretary.
Sec. 4. This order is not intended to, and does not, create any right or benefit enforceable at
law or equity by any party against the United States, its departments, agencies, entities,
officers, employees or agents, or any other person.
Sec. 5. Executive Order 12452 of December 22, 1983, is hereby revoked.
B THE WHITE HOUSE, April 4, 2003. [FR Doc. 03-8832 Filed 4-9-03; 8:45 am] Billing code 3195-
01-P
IQ L (2/20)
Appendix M
Monroe County Department of Public Health Tuberculosis
Delinquent Cases/Suspects Procedures
IQ M (2/20)
Monroe County Department of Public Health Section 13 - Page 2
TB Control Program Revised: 10/11
TB Policies Reviewed: 11/13
DELINQUENT CASES/SUSPECTS
I. Delinquent Cases/Suspects: Management
A. The case manager is responsible for following up with these cases/suspects for
their clinic appointment as ordered by the MCDPH clinic physician. The case
manager is also required to notify the patient of this appointment well in advance,
whenever possible.
B. If a case/suspect misses a clinic appointment the case manager is to contact the

patient, attempt to identify the reason the appointment was missed and
reschedule the appointment for the next available clinic session. The case
manager will make every very effort to accommodate the patient and remove any
barriers to attending clinic. (e.g. by providing transportation, accommodating
preferred visit times, if possible, etc.).
C. If a case/suspect misses three consecutive clinic appointments in spite of every

effort to accommodate them, the case manager is to notify a nursing supervisor
of the need for further intervention.
D. The TBCP supervisors will present the information to the Director of Health for
determination of an appropriate course of action. An appropriate course of action
may include: contracting to care, deputy referrals, a letter from the Director of
Health or court action.
E. The Monroe County Sanitary Code 569-77 and NY State PHL 2100 (2) and SSC
2.25 establish the TB Control Program’s ability to ensure treatment of non-
compliant patients. The Monroe County Director of Health (or designee,) in
collaboration with the Monroe County Law Department, will act according to
these mandates.
F. The TB Program Coordinator or Director of Health or designee will notify the

County Attorney to initiate the process of legal removal and/or detention to the
appropriate health care facility. If there are questions or concerns regarding
communicability or if the patient is known to be contagious, the facility must place
the patient in a satisfactory AFB isolation room and use respiratory precautions.
The patient will be kept in AFB isolation until they are deemed to be no longer
contagious.
G. The following documents will be prepared:

.
1. Petition for an Order of Detention: documents violation of Public Health
Law and County Sanitary Code; prepared and signed by the County
Attorney.
IQ M (2/20)
2. Order for Removal or Detention: documents patient’s failure to comply with

adequate treatment using less restrictive measures; prepared by Program
Coordinator or designee and signed by Health Director.
3. Health Director’s Affidavit in Support of Order of Commitment: provides

background information about TB and medical necessity of treatment;
documents specific attempts to gain patient’s compliance and patient’s
responses; prepared by Program Coordinator or designee and signed by
Health Director.
4. Supplemental Affidavit: may be used if conditions of commitment change

during the process; signed by the Director of Health
5. Exparte Motion for an Order to Show Cause: Prepared and submitted by

the County attorney to the State Supreme Court.
6. Order to Show Cause: Directs the patient to appear before the judge and
to show cause why the order of commitment should not be upheld; signed
by the State Supreme Court judge.
7. Attachments as needed. All medical records must be certified copies.
H. Every aspect of this process must be documented in the patient’s record.
I. Service of Order to Remove or Detain
1. The Order must be served to the patient in person. It may be served by a

TB Program employee or by a process server.
2. The patient must be informed of his/her right to an attorney.
3. The patient will be asked whether there are any contacts he/she would like
to have assistance with (ex. notifying family members of the detention
order) and will receive assistance from the TB Program staff as needed.
4. The patient will be asked to sign a receipt of service.
5. Copies of the Order will be left with the patient and the health care facility.
A copy will be placed in the patient’s chart. The original will be delivered
to the Monroe County Law Department, along with an Affidavit of Service.
J. Court Order and Follow Up: The MCDPH TB Control Program (TBCP) will
adhere to the Monroe County Sanitary Code (569 – 83 – 88) in following all
required elements of detention and commitment of a person with tuberculosis.
IQ M (2/20)
A patient who is detained/committed will have his/her case reviewed by the court
every ninety days.
II. DELINQUENT CASES/SUSPECTS: DOT
A. Each suspect and case of tuberculosis will be monitored for compliance

(adherence) to their treatment course on an ongoing basis. This monitoring will
be the responsibility of the nursing care team. This team includes the outreach
worker / nurse, the case manager, the clinic charge nurse, the outreach services
coordinator and the program coordinator.
B. Each outreach worker/nurse is required to report to the case manager (and/or the
outreach services coordinator) any time a person considered a case/ suspect
misses an ordered dose of medication for any reason. The outreach worker will
attempt to locate any patient who may be “missing”. This may include visiting the
home, the work place or school or any other location the patient is known to
spend time. Special attention should be made to protecting the patient’s
confidentiality when attempting to locate them at an alternate visit site.
C. The case manager is required to monitor each case/suspect closely for

adherence to treatment. Any time a case / suspect is noted to be missing a
significant number of doses (not to exceed 20% of the prescribed doses) the
case manager is required to discuss the patient in a care conference. During this
conference all potential barriers to the patient’s adherence will be discussed.
Consideration will be given to how to enable staff to individualize and maximize
the patient’s treatment, so they may adhere to the treatment course. A telephone
call and/or visit will be made to the patient by either the case manager or the
outreach services coordinator to obtain his/her input about how the program can
assist with medication compliance.
D. If the patient continues to miss doses of DOT, the following will ensue:
1. A letter will be sent to the patient from the Director of Health (or designee)
explaining the importance of adhering to the treatment regimen and the
legal implications of non-adherence.
2. The patient will be scheduled to attend the next available physician clinic
session. The physician and one of the nursing supervisors (i.e. clinic
charge nurse, outreach coordinator and/or program coordinator) will meet
with the patient and discuss barriers to their treatment, ramifications of not
receiving treatment and provide counseling to the patient as needed.
Alterations to the treatment plan will be made as indicated from this
meeting.
IQ M (2/20)
3. The patient will be offered all available options to ensure future adherence
including, but not limited to: contracting for DOT visits times and locations,
incentives to encourage adherence and notice of potential legal
interventions. These legal interventions may include detention, isolation,
interruption of employment / school, etc.
E. If the patient continues to miss doses of DOT, or if the patient refuses to attend
the above noted clinic session, the nursing supervisor(s) will petition the director
of health (or designee) to review the case. A memo containing the patient’s
treatment records, medical and mental health diagnosis, all efforts attempted by
the TBCP to enhance adherence, why they failed and any other pertinent data
will be sent to the Director of Health. The Director of Health will then determine
the next course of action (see Monroe County sanitary code 569-77 and
NYSPHL2100(2))
F. All aspects of this process must be documented clearly and completely in the
patient record.
IQ M (2/20)
APPENDIX N ACRONYMNS
AIIR Airborne Infection Isolation Room

CD Communicable Disease
CDC Centers for Disease Control and Prevention
COOP Continuity of Operations Plan
DCU Disease Control Unit
EMS Emergency Medical Services
EOC Emergency Operation Center
EPI Epidemiology
HEPA High Efficiency Particulate Air
I&Q Isolation and Quarantine
MCDPH Monroe County Department of Public Health
MCH Monroe Community Hospital
MOU Memorandum of Understanding
NYSDOH New York State Department of Health
OEM Office of Emergency Management
OPHP Office of Public Health Preparedness
PHEPR Public Health Emergency Preparedness and Response Plan
PHOC Public Health Operation Center
PPE Personal Protective Equipment
TB Tuberculosis
IQ N (2/20)

Monroe County Isolation and Quarantine Plan

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Monroe County Isolation and Quarantine Plan

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Department of Public Health

Monroe County, New York

Adam J. Bello Michael D. Mendoza, MD, MPH, MS, FAAFP

ISOLATION AND QUARANTINE

111 Westfall Road • Rochester, New York 14620

Signature: ________//Original Signed//______________ Date: __2/01/2020_________

1 All 10/14/2014 Sayers/S. Sharp Updated – Rev. 2

2 All 10/21/2014 L. Kozelsky Page numbers updated

3 Chapter 4 10/21/2014 Sayers MCSO/LE Roles

Term “Director’s Order”

5 Appendix A 1/29/2015 L. Kozelsky Housekeeping

Appendix A1 – Housekeeping- new

CHAPTER 1: INTRODUCTION ............................................................................................................ 1

CHAPTER 2: PLANNING ASSUMPTIONS ............................................................................................ 5

CHAPTER 3: ROLES AND RESPONSIBILITIES....................................................................................... 6

CHAPTER 4: CONCEPT OF OPERATIONS ............................................................................................ 9

CHAPTER 5: PROTOCOL FOR VOLUNTARY ISOLATION AND QUARANTINE ....................................... 11

CHAPTER 7: PROTOCOL FOR INVOLUNTARY ISOLATION OR QUARANTINE BY COURT ORDER .......... 21

This plan applies to:

2.1 PLANNING ASSUMPTIONS

3.1 MONROE COUNTY DEPARTMENT OF PUBLIC HEALTH

3.2 MONROE COUNTY ATTORNEY

3.3 MONROE COUNTY SHERIFF’S OFFICE (MCSO)

3.4 OTHER LAW ENFORCEMENT AGENCIES

3.5 MONROE COUNTY OFFICE OF PROBATION AND CORRECTIONS

3.6 MONROE COUNTY SUPREME COURT

3.7 APPELLATE DIVISION COURT

3.8 EMERGENCY MEDICAL SERVICES

3.9 MONROE COUNTY HOSPITALS

3.10 MONROE COUNTY PHYSICIANS

3.11 MONROE COUNTY OFFICE OF EMERGENCY MANAGEMENT

4.2 DIRECTION AND CONTROL

4.2.2 Medium Scale Outbreak (greater than 10/less than 50 individuals)

4.3 HEALTH ORDER VS. COURT ORDER

4.4 REQUESTING STATE OF EMERGENCY

5.1 LEGAL DOCUMENTS UTILIZED FOR VOLUNTARY ISOLATION AND QUARANTINE

5.2 DETERMINATION OF NEED FOR VOLUNTARY ISOLATION OR QUARANTINE

5.3 NOTIFICATION FOR VOLUNTARY ISOLATION OR QUARANTINE

5.4 CONTENTS OF THE AGREEMENT LETTER REQUESTING VOLUNTARY ISOLATION OR QUARANTINE

5.5 METHOD OF ISOLATION OR QUARANTINE

5.6 TRANSPORTATION OF PATIENTS

5.7 PROTECTION OF HEALTH WORKERS AND HOUSEHOLD MEMBERS

5.8 PERSONAL NEEDS OF PATIENTS

5.9 COMPLIANCE MONITORING PLAN

5.10 NON-COMPLIANCE WITH A REQUEST FOR VOLUNTARY ISOLATION OR QUARANTINE

6.2 DETERMINATION OF NEED FOR INVOLUNTARY ISOLATION OR QUARANTINE

6.3 ISSUING A HEALTH ORDER FOR INVOLUNTARY ISOLATION OR FOR QUARANTINE

6.4 SERVING A HEALTH ORDER FOR ISOLATION OR QUARANTINE

6.6 METHOD OF INVOLUNTARY ISOLATION OR QUARANTINE

6.7 TRANSPORTATION OF PATIENTS

6.9 COMPLIANCE MONITORING PLAN

6.10 ENFORCEMENT OF ORDER

6.11 NON-COMPLIANCE WITH A HEALTH ORDER

7.1 OBTAINING A COURT ORDER FOR INVOLUNTARY ISOLATION OR QUARANTINE

7.2 PETITION/ORDER TO SHOW CAUSE FOR ISOLATION OR QUARANTINE

7.3 AFFIDAVIT OF THE COMMISSIONER

7.4 PROCEDURE FOR FILING THE PETITION/ORDER

7.7 COURT ORDER FOR ISOLATION OR QUARANTINE

7.8 SERVING THE COURT ORDER FOR ISOLATION OR QUARANTINE

7.9 CONTINUATION OF COURT ORDER FOR ISOLATION OR QUARANTINE

7.10 CONSOLIDATION OF CLAIMS INTO GROUPS

Signature: //Original Signed// Date: 2/01/2020_____

__________________ _ Date: _

__________________ _ Date: ____

__________________ _ Date: _____

__________________ _ Date: ____

Dated: ___________________________

Date: ___________

Date: ____________________________

Date: ___________

on , 20.

__________facility in accordance with the Health Order dated _.

investigated Respondent’s exposure, and on determined that Respondent posed an