CESU Copy Republic of the Philippines

Quezon City Health Department

EPIDEMIOLOGY AND SURVEILLANCE UNIT
Democracy Building, QC Memorial Circle, Quezon City
Tel. No. 8703-2759, 8703-4398, 0916-122-8628, 0908-639-8086
Email: qcsurveillance@quezoncity.gov.ph
Facebook: QCEpidemiologyDiseaseSurveillance

ISOLATION / QUARANTINE ORDER

Name/s: Facility Health Status Vaccination Status Issued by:

____________________ Hosp Home Symptomatic Asymptomatic Fully Vaccinated Booster Partial/Not __________________ __________
Disease Surveillance Officer Date & Time Issued:
____________________ Hosp Home Symptomatic Asymptomatic Fully Vaccinated Booster Partial/Not

Received by:
____________________ Hosp Home Symptomatic Asymptomatic Fully Vaccinated Booster Partial/Not

____________________ Hosp Home
____________________ Hosp Home
_______________________
Symptomatic Asymptomatic Fully Vaccinated Booster Partial/Not
Patient’s Name/Head of the Family
Symptomatic Asymptomatic Fully Vaccinated Booster Partial/Not
Note:

Address: _________________________________ Contact No: _______________ • Non-compliance to this order is punishable

under Rule IX Sec. 1 of the 2020 Revised
Patient/s or household member/s are hereby directed to undergo strict isolation/quarantine Implementing Rules and Regulations of
from _______ (onset date 1st symptomatic/swab date of positive household member) until Republic Act No. 11332, or the Mandatory
_________ (end of isolation/quarantine of patient itself or all close contact). Isolation can be Reporting of Notifiable Diseases and Health
discontinued upon completion of the recommended isolation period, provided that no fever for Events of Public Health Concern Act.
• This order is based on Department of Health
at least 24 hrs. w/o the use of anti-pyretic medications & shall have improvement of respiratory
Memorandum 2022-0433 dated September
signs & symptoms. 13, 2022 wherein a confirmed fully vaccinated
patient should isolate at least 7 days and 10
Remarks: days for those partially or unvaccinated. A
fully vaccinated asymptomatic close contact
should quarantine for 0 day. If partially or
unvaccinated at least 14 days from last day of
exposure.
•

Republic of the Philippines

Patient’s Copy Quezon City Health Department
EPIDEMIOLOGY AND SURVEILLANCE UNIT
Democracy Building, QC Memorial Circle, Quezon City
Tel. No. 8703-2759, 8703-4398, 0916-122-8628, 0908-639-8086
Email: qcsurveillance@quezoncity.gov.ph
Facebook: QCEpidemiologyDiseaseSurveillance

ISOLATION / QUARANTINE ORDER

Name/s: Facility Health Status Vaccination Status Issued by:

__________________ Hosp Home Symptomatic Asymptomatic Fully Vaccinated Booster Partial/Not __________________ __________
Disease Surveillance Officer Date & Time Issued:
__________________ Hosp Home Symptomatic Asymptomatic Fully Vaccinated Booster Partial/Not

Received by:
__________________ Hosp Home Symptomatic Asymptomatic Fully Vaccinated Booster Partial/Not

_______________________
__________________ Hosp Home Symptomatic Asymptomatic Fully Vaccinated Booster Partial/Not Patient’s Name/Head of the Family
__________________ Hosp Home Symptomatic Asymptomatic Fully Vaccinated Booster Partial/Not
Note:

• Non-compliance to this order is punishable

Address: ___________________________________ Contact No: ______________ under Rule IX Sec. 1 of the 2020 Revised
Implementing Rules and Regulations of
Patient/s or household member/s are hereby directed to undergo strict isolation/quarantine Republic Act No. 11332, or the Mandatory
from _______ (onset date 1st symptomatic/swab date of positive household member) until Reporting of Notifiable Diseases and Health
_________ (end of isolation/quarantine of patient itself or all close contact). Isolation can be Events of Public Health Concern Act.
discontinued upon completion of the recommended isolation period, provided that no fever for • This order is based on Department of Health
at least 24 hrs. w/o the use of anti-pyretic medications & shall have improvement of respiratory Memorandum 2022-0433 dated September
13, 2022 wherein a confirmed fully vaccinated
signs & symptoms.
patient should isolate at least 7 days and 10
days for those partially or unvaccinated. A
Remarks: fully vaccinated asymptomatic close contact
should quarantine for 0 day. If partially or
unvaccinated at least 14 days from last day of
exposure.
•