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Public Health Agency of Canada (PHAC)
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CORONAVIRUS DISEASE (COVID-19) CASE REPORT FORM - PROTECTED B WHEN COMPLETED

National • English • Medical Tips/Forms

CASE REPORT FORM used by the Public Health Agency of Canada (PHAC) if individuals come in contact with COVID-19

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Head Office:

211 Akwesasne International Rd.

Akwesasne, ON K6H 0G5

Ottawa Office:

310 - 303 Moodie Drive

Kanata, ON K2H 9R4

Telephone: 613-599-6070

Toll-free: 1-844-218-0440

Fax: 613-319-8092

Email: info@fnhma.ca

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