Appeal of Order of Isolation, Quarantine or Vaccination PC-9011

Form Template

Emergency medical vaccination, isolation and quarantine can be enforced by a local health authorities for disease control when health officials believe people are at risk for the spread of communicable diseases, such as pandemic influenza, measles or chicken pox.

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When patients are under medical vaccination, isolation or quarantine by the health department, but do not believe they are being held legally, they can appeal the order of isolation, quarantine or vaccination. The Appeal of Order of Isolation, Quarantine or Vaccination PC-9011 app will guide the user through the appeal process. The user should demonstrate why they feel they are being confined illegally by health officials or by disease control regulations imposed by local government, as well as demonstrate that they are not a rick to public health and will not transmit an infectious or communicable disease. Users will be able to designate a legal representation in the app, and materials should be submitted to a court of law.

Features
  • Signature Capture
  • Image Capture
  • Conditional Fields
  • Submission Editing
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Platforms
  • iPhone
  • iPad
  • Android
  • Windows
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Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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