BEFORE THE IOWA DEPARTMENT OF PUBLIC HEALTH

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DIRECTED TO: ) \_\_\_\_\_\_\_\_\_\_\_\_\_

) *Order \#*

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# Name

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# Street Address 

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*City, State, Zip* **HOME QUARANTINE ORDER**

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The Iowa Department of Public Health (the Department) has determined
that you have had contact with measles (Rubeola). Measles is a highly
contagious disease that is spread from person to person. Symptoms
usually include rash, high fever, cough, runny nose, and red, watery
eyes.

Community spread of measles will have severe public health consequences.
The spread of measles can be stopped by giving preventive treatment
(vaccines or immune globulin) to those who have been exposed *and* who
have neither been previously vaccinated nor acquired a natural immunity
to the disease. Persons who are susceptible and refuse vaccination are
at risk of contracting and spreading the disease.

The Department has the authority to place anyone who poses a risk of
spreading measles in home quarantine. Quarantine in private homes is
used because it is the least restrictive means of protecting the
community.

The Department has determined that you pose a risk to others because:

-   You have been exposed to measles; *and*

-   You may not be immune to measles; *and*

-   You did not receive preventive treatment in a timely manner.

**Therefore, the Department is placing you under a home quarantine
order.** **While this order is in effect, you are required to remain in
your home and comply with the following provisions:**

1\. **Terms of confinement.** You are ordered to remain in your home at
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from \_\_\_\_\_\_\_\_through\_\_\_\_\_\_\_\_. *Street Address, City,
State Date Date*

2\. **Requirements during confinement.** During the period of
quarantine:

A.  You must not leave your home at any time unless you have received
    prior written authorization from the Department to do so.

B.  You must remain accessible by telephone at all times and answer and
    respond fully and truthfully to telephone calls from Department
    staff and other persons identified by the Department as acting on
    behalf of the Department.

C.  You must not come into contact with anyone except the following
    persons:

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(i) family members and other persons who reside in your home;

(ii) authorized healthcare providers;

(iii) authorized Department staff or other persons identified by the
      Department as acting on behalf of the Department; and

(iv) such other persons as authorized by the Department.

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D.  If family members or other persons who reside in your home have not
    been issued a Home Quarantine Order, they may leave your home to
    carry on their daily routines and to assist you with any needs you
    may have during the period of confinement. If you live alone, or if
    every member of your household is under Home Quarantine Order, you
    should arrange by telephone for relatives, neighbors, or friends to
    assist with any needs you may have during the period of confinement.
    These persons should not have direct contact with you. If you need
    assistance in providing for your daily needs, you should call the
    Department free of charge at (800) 362-2736 and ask to speak to the
    Center for Acute Disease Epidemiology (CADE) duty officer.

E.  You must follow the directions contained in the attachment to this
    order labeled Attachment A to monitor your health status on a daily
    basis.

F.  If you develop any symptoms of measles detailed in Attachment A,
    including rash, high fever, cough, runny nose, and red, watery eyes,
    you should immediately call the Department free of charge at (800)
    362-2736 and ask to speak to the CADE duty officer. You should also
    telephone your family physician. You must inform your physician that
    you are under Home Quarantine Order. If emergency medical treatment
    is required for conditions other than those listed in this paragraph
    (e.g. chest pain or severe accidental injury at home), you should
    call 911 for an ambulance. When seeking such assistance, you must
    inform the operator of the 911 line and the ambulance that you are
    under Home Quarantine Order.

G.  If other persons also reside in your home you must maintain good
    personal hygiene at all times, including complying with the
    directions contained in Attachment A, to prevent disease
    transmission.

H.  You should inform your employer that you are under home quarantine
    and are not authorized to come to the work place.

I.  If you have additional questions about this order or what is
    required of you to remain in compliance with it, call the Department
    free of charge at (800) 362-2736 and ask to speak to the CADE duty
    officer.

3\. **Information about measles.** You should review the information
contained at Attachment A for information about measles. In order to
find out more information about measles and its symptoms and spread, you
may access the Department's web-page at
[www.idph.state.ia.us.]{.underline} If you do not have access to the
internet from your home, you may contact the Department at (800)
362-2736.

4\. **Legal authority.** This order is issued pursuant to the legal
authority contained at Iowa Code chapter 139A, and 641 Iowa
Administrative Code chapter 1, a copy of which is labeled Attachment B
and is attached to this order for your review. The Department shall
comply with the principles for quarantine contained in subrule 1.9(3) of
this attachment when issuing and implementing this order.

5\. **Ensuring compliance.** In order to ensure that you strictly comply
with this Home Quarantine Order the Department or persons authorized by
the Department may contact you by telephone on a regular basis and may
visit you at your residence without prior notification to you.

6\. **Violations of order.** If you fail to comply with this Home
Quarantine Order you may be ordered to be quarantined in a hospital or
other facility as determined by the Department. In addition, failure to
comply with this order is a simple misdemeanor for which you may be
arrested, fined, and imprisoned.

7\. **Your rights -- appeal rights.** While under quarantine you have
the rights as described in subrule 1.9(8) of Attachment B. In addition,
you have the right to appeal this order pursuant to subrule 1.9(7) of
Attachment B.

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PATRICA QUINLISK, MEDICAL DIRECTOR *DATE*

IOWA DEPARTMENT OF PUBLIC HEALTH

Lucas State Office Building

Des Moines, IA 50319

**I have read and understand the above Quarantine Order**

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**Signature Date**

Attachments to this Order: Attachment A \-- Facts About Measles

Attachment B \-- 641 Iowa Administrative Code chapter 1