Medical Clearance to end self isolation after COVID-19 diagnosis.
Date: ____________
Patient Name:_________________________________________________ DOB:_____________
Patient received a POSITIVE COVID-19 diagnosis on: ___________________________.

This patient has completed their 10-day isolation period following a diagnosis of COVID-19 and have
met CDC criteria to be released from isolation.

At least 24 hours have passed since the resolution of fever without the use of fever-reducing
medications AND improvement in symptoms (cough, shortness of breath, etc.)

Patient was evaluated and able to return to work / school.

Re-testing not included unless required by employer / school.
This statement is valid based on relevant information on the date below, but may change based on new
symptoms, exposures, or results. The patient should seek medical care for any new concerns.
Signature: ___________________________________________ Date: ________________