Republika ng Pilipinas

Republic of the Philippines

TANGGAPANG LUNGSOD SA PANGKALUSUGAN
City Health Office
T and D Vill. cor. Col. P. Cruz St., Tuktukan, Taguig City
TeleFax no. (02) 8-642-1262, E-mail: chotaguig@yahoo.com

Certification of Exposure to Suspect, Probable or Confirmed

COVID-19 Cases Form

DATE: March 4, 2022

This is to certify that the exposure of Ms./Mr. name ,

position (position), to COVID-19 for the following reasons:
(Please check appropriate boxes)

Providing direct care to COVID 19 patients;

Having face to face contact (within one meter) with suspect, probable, or confirmed
COVID-19 patient or hospital staff/personnel.
(Note: Suspected COVID-19 patient refers to 1. A person who meets the clinical AND
epidemiological criteria, 2. A patient with severe acute respiratory illness, and 3.
Asymptomatic person not meeting epidemiologic criteria with a positive SARS-CoV-2
Antigen-RDT:
Clinical Criteria Epidemiological Criteria:

ˑ Acute onset of fever AND cough; OR
ˑ Acute onset of ANY THREE OR MORE of the
following signs or symptoms; fever, cough,
general weakness/fatigue. Headache, myalgia,
sore throat, coryza. Dyspnea, anorexia,
nausea/vomiting, diarrhea, altered mental
status.
 ˑ Residing or working in an area with high risk
of transmission of virus: closed residential
settings, humanitarian settings such as camp
and camp-like settings for displaced persons;
anytime within the 14 days prior to symptom
onset; or
ˑ Residing or travel to an area with community
transmission anytime within the 14 days prior
to symptom onset; or
ˑ Working in any health care setting, including
within health facilities or within the
community; any time within the 14 days prior
of symptom onset.

Being present while any form of aerosol generating procedure (AGP) is performed on COVID19
/s (e.g. Nebulizer Treatment, etc.);

Having direct contact with the environment where confirmed, suspected, and
probable COVID 19 patients are being cared for (e.g. bed, linens, waste bins,
medical equipment, bathroom, etc,);

Collecting ad processing or sample for COVID 19 testing;

Involved in transport of COVID 19 patients

Certified by:

, ,
(Signature over printed name of Immediate Supervisor, designation & department/health center)

NORENA R. OSANO, MD
City Health Officer
Taguig City

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