Letter of Instruction for

Quarantine or Isolation

You are being placed in:

 Isolation (symptomatic)
 Quarantine (no symptoms)
End Date of Quarantine (if no symptoms develop): ________________
Patient Name: __________________________
Medical Provider/ Hospital Name: ______________________________
Start Date of Quarantine or Isolation: ______________

Dear Patient,

You have been identified as high risk for COVID-19 infection. This has been determined due to your close
proximity with a confirmed COVID-19 case, symptoms, or because of a pending lab test. You are ordered
to isolate/quarantine pursuant to the Fresno County Health Officer Order declared on March 27, 2020 or
Madera County Health Officer Order declared on March 24, 2020 related to COVID-19. This information
sheet provides instructions to people who have COVID-19, have COVID symptoms, or who had close
contact with a person who has been confirmed as having COVID-19.

Isolation (Symptoms of COVID-19)

Isolation means staying indoors and completely avoiding contact with other people. This includes
staying away from other people in your household. You need to do this if you have any symptoms of
COVID-19 - this is to stop other people from getting infected, especially vulnerable people in your
household and community. You do not have to get tested or have positive test results to be in isolation.

What to Do in Isolation

 Follow the instructions on the attached What to Do When in Quarantine or Isolation.

 Track your symptoms on the attached Isolation Symptom Tracker.

You are finished with isolation only when:

 You have a negative or “not detected” COVID-19 test result.

OR when:

1. It has been 7 days since your first symptoms started AND

2. You have not had a fever for 3 days

SP 3/30/2020 Page 1
 Letter of Instruction for
Quarantine or Isolation

Quarantine (Close Contact with No Symptoms)

Quarantine means completely avoiding contact with other people for 14 days. This includes staying
away from other people in your household. In Quarantine you can go outside to walk, run or exercise on
your own. Quarantine stops other people from getting infected, especially vulnerable people in your
household and community. You will likely not be tested unless you develop symptoms.

You are in quarantine because you are a close contact of a confirmed case of coronavirus. A close
contact is anyone who has had greater than 15 minutes of face-to-face (less than 6 feet distance)
contact with a confirmed case in any setting.

Close contact can be:

 Household contacts - defined as living or sleeping in the same home, individuals in shared
accommodation sharing kitchen or bathroom facilities and sexual partners
 Closed space contact. For those contacts who have shared a closed space with a confirmed case
or longer than two hours, a risk assessment should be undertaken taking into consideration the
size of the room, ventilation and the distance from the case
 Healthcare workers who have not worn appropriate personal protective equipment (PPE) or who
have had a breach of PPE
 Passengers on an aircraft sitting within two seats (in any direction) of the COVID-19 case, travel
companions or persons providing care, and crew members serving in the section of the aircraft
where the case was seated

Next Steps

1. If you work in healthcare, you need to contact your manager and let them know that you have
been identified as a close contact of a case of COVID-19.

2. You will be contacted by staff at the Fresno or Madera Departments of Public Health. If you do
not get a call in the next 3 days, call:

 If you live in Fresno County call (559) 600-3200.

 If you live in Madera County call (559) 675-7893.

3. If you stay free of symptoms, you can come out of quarantine in 14 days.

4. If you develop symptoms, you need to start isolation (see above) and call the Health
Department right away at the numbers above.

If You Need to See a Doctor

If you need to see a doctor CALL AHEAD for instructions. DO NOT go the ER or the doctor unless you call
ahead and you are told to do so. Follow all of the other advice given by your doctor.

If you get very ill and it is an emergency, call 911. Make sure to tell them you have COVID-19 symptoms.

SP 3/30/2020 Page 2
 Letter of Instruction for
Quarantine or Isolation

Health Officer Order

We, as Public Health Officers for the Counties of Fresno and Madera, as duly authorized under the
Health and Safety Code, Section 120175, are requiring that citizens of Fresno and Madera Counties
comply with the lawful orders to isolate or quarantine related to Novel Coronavirus Disease (COVID-19).

California Health and Safety Code Section 120275 makes it a misdemeanor for any person, after notice,
to violate, or refuse or neglect to conform to, any rule, order, or regulation prescribed by any health
officer for the quarantine or disinfection of persons. Failure to comply with a lawful isolation or
quarantine order may result in the person being taken into custody for the isolation period, along with a
fine or imprisonment.

If you have any questions or concerns, contact:

 Fresno County Department of Public Health at (559) 600-3200

 Madera County Department of Public Health at (559) 675-7893

Rais Vohra, MD Simon Paul, MD

Fresno County Public Health Officer Madera County Public Health Officer

3/30/2020

SP 3/30/2020 Page 3
 WHAT TO DO WHEN IN
QUARANTINE OR ISOLATION

If you are in quarantine or isolation due to COVID-19, follow the steps below to help protect other people in your
home and community.

Stay home except to get Clean your hands often

medical care.
Do not go to work, school, or public
places. Ask others to get essentials for
you. Avoid public transportation.
Wash your hands often with soap and
water for 20 seconds or Use hand
sanitizer alcohol based, with at least
60% alcohol if soap and water are not
available.

Separate yourself from other

Avoid sharing personal
people in your home who are
household items.
not in quarantine or isolation. Do not share dishes, drinking glasses,
Try to stay in a specific “sick room” cups, eating utensils, towels, or
and use a separate bathroom if bedding with other people in your
available. Limit contact with pets & home who are not in quarantine or
animals isolation.

Call ahead before visiting your Clean all “high touch” surfaces
doctor everyday
If you have a medical need, call your Everyday clean high-touch surfaces in
doctor or hospital, tell them you may your area like; phones, remote
have COVID-19 and follow their controls, counters, tabletops,
instructions. doorknobs, toilets, keyboards, tablets
and bedside tables.
Wear a mask if you are sick
Wear a mask when you are around Monitor your symptoms
other people in your home and before Seek medical care right away if your
you enter a healthcare provider’s illness is worsening, but call first.
office. Follow care instructions from your
healthcare provider and local health
department. Your local health dept.
will give you instructions on checking
Cover your coughs and sneezes your symptoms and reporting
Cover your mouth and nose with a information.
tissue when coughing or sneezing.
Dispose of the tissue in a lined trash Follow quarantine order
can. Wash your hands immediately Failure to follow quarantine
after for 20 seconds. instructions may result in civil or
criminal penalties.

If you develop symptoms for COVID-19 call your County Department of Public Health immediately.

COVID 19 symptoms include:

 Fever • Sore throat • New or worsening shortness of breath • New or worsening of cough
 Please consult your medical provider for any other symptoms that are severe or concerning.
 Call 911 if you have a medical emergency: If you have a medical emergency and need to call 911, notify the operator that you
have or think you might have, COVID-19. If possible, put on a facemask before medical help arrives.

Fresno (559) 600-3200 Madera (559) 675-7893

EM 3/25/2020
 Isolation Symptom Tracker

Date placed in isolation: _______________________

DATE/ TEMPERATURE/ SYMPTOMS/
FECHA TEMPERATURA SINTOMAS
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Day 10

YOU CAN STOP WHEN:

1. No fever (temperature above 100.4 F) for 3 full days and no use of fever reducing
medicine AND
2. At least 7 days have passed since symptoms first appeared AND
3. Other symptoms have improved
If you were placed in isolation by Department of Public Health, you need to be released from
ISOLATION by Department of Public Health.
USTED PUEDE PARAR CUANDO:
1. No tenga fiebre (temperatura de mas de 100.4 F) por 3 días completos y sin usar
medicina para reducir su fiebre
2. Por lo menos 7 días han pasado desde que tuvo su primer síntoma Y
3. Sus otros síntomas han mejorado
Si usted fue puesto en AISLAMIENTO por el Departamento de Salud Pública, es necesario que
el Departamento de Salud Publica también lo deje salir de aislamiento.

SB 3/30/2020
 Isolation
Work Release

Medical Provider/Hospital Name: ____________________________________

Patient County of Residence:  Fresno  Madera

Patient Name: _______________________________________

This patient is ordered to not report to work until

 They have a negative or “not detected” COVID-19 test result.
OR when:
1. It has been 7 days since their first symptoms started AND
2. They have not had a fever for 3 days

If you have any questions or concerns, contact the Department Public Health in which the
patient resides.

 Fresno County Department of Public Health at (559) 600-3200

 Madera County Department of Public Health at (559) 675-7893

____________________________________ ___________
Medical Provider/ Assistant Date

Rais Vohra, MD Simon Paul, MD

Fresno County Public Health Officer Madera County Public Health Officer

3/30/2020

SB 3/30/2020