Healthcare Provider Guidance

COVID-19 Case Definition & Command Notifications

Revised 17 April 2020

CASE DEFINITIONS

SYMPTOMS: 2019 coronavirus disease (COVID-19) is a viral illness of the respiratory tract caused by the novel 2019 

coronavirus (SARS-CoV-2). Clinical presentation and symptoms may range from no symptoms to moderate or severe symptoms. 

Symptoms may be assessed in outpatient, telehealth, or inpatient settings. Settings and symptoms consistent with COVID-19 

include:

• Outpatient or telehealth setting:

o Must have at least TWO of the following symptoms: fever (measured or subjective), chills, rigors, myalgia,

headache, sore throat, new olfactory and taste disorder(s) OR at least ONE of the following: cough, shortness of

breath, or difficulty breathing

• Inpatient setting:

o Severe respiratory illness including one or more of the following: Clinical or radiographic evidence of

pneumonia OR Acute respiratory distress syndrome (ARDS)

EPIDEMIOLOGIC LINKS/EXPOSURES include the following in the 14 days before onset of symptoms: 

• Close contact

o Close contact is defined as a) being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged

period of time (>10 minutes); close contact can occur while caring for, living with, visiting, or sharing a health

care waiting area or room with a COVID-19 case; or, b) having direct contact with infectious secretions of a

COVID-19 case (e.g., being coughed on).

• Exposure:

o Close contact with a confirmed or probable case of COVID-19 disease; OR Close contact with a person with

clinically compatible illness AND linkage to a confirmed case of COVID-19 disease; OR Travel to or residence

in an area with sustained, ongoing community transmission of SARS-CoV-2 OR in an at risk cohort as defined

by public health authorities during an outbreak.

DIAGNOSIS: COVID-19 cases may be determined by meeting either a confirmed case diagnosis (meeting laboratory criteria) or 

probable case diagnosis (meeting clinical criteria): 

Confirmed Case (laboratory criteria): 

• Must have a positive laboratory test with SARS-CoV-2 nucleic acid (RNA) detected by molecular amplification detection

(example: PCR, sequencing, NAAT).

Probable Case (clinical criteria): 

• Must have ALL of the following:

o Meets either clinical description as described above with no alternative more likely diagnosis AND no

confirmatory COVID-19 lab testing performed with no intent to test AND one or more epidemiologic

link/exposure in the 14 days before onset of symptoms

OR

• Must have the following:

o Meets either clinical description as described above with no alternative more likely diagnosis OR one or more

epidemiologic link/exposure in the 14 days before onset of symptoms; AND

o Laboratory detection of either of the following: Specific antigen in a clinical specimen OR specific antibody in

serum, plasma, or whole blood indicative of a new or recent infection (example: positive IgM antibody or an

increase in antibody titer between acute and convalescent sera).

COMMAND NOTIFICATIONS

Command notification is critical throughout this process. Providers may use the standard Individual Sick Slip (DD Form 689) to 

notify Unit Commanders on the status of their personnel. Template is available in Enclosure 1. The Fleet Liaison Officer and/or

Preventive Medicine Department must work closely with the supported MTF to ensure that commands are notified whenever a 

service member is placed on ROM, quarantine, or isolation whether testing is performed or not. Ensure that CCIR reports annotate 

whether the case is “probable” or “confirmed”.
Influenza-Like Illness or 

COVID-19 Exposure 

Emergency Room (ER) 

evaluation, anticipated hospital 

admission. 

Prolonged 

Close Contact with 

COVID-19 patient, or Member of Fleet Unit 

deploying within 

30 days.

DEFINITIONS:Severe Signs/Symptoms: Respiratory distress, chest pain, cyanosis, confusion, lethargy, loss of consciousness.Prolonged Close Contact: Personnel within 6 feet for > 10 minutes.(Per Unit Medical Dept. determination)Isolation: separates an individual who is infected with a contagious disease from persons who are not sick.Restriction of Movement (ROM) = Quarantine: separates and restricts the movement of persons who were exposed to a disease to see if they become sick.

1. High risk for COVID-19.2. ER Evaluation.3. Testing will be done as 

supplies allow. Operational Forces will be priority.

CO

No

COVID-19 Patient Flowchart

Rev: 17Apr20 (Ad

Test Performed

Test Positive

Yes

Member reports 

Symptoms of COVID-19

consistent with clinical 

description* below.

Severe Signs or 

Symptoms of

COVID-19

No

Yes Yes

Influenza-Like Illness

1. Member to remain at home on SIQ.2. Member to notify Unit provider or PCM if symptoms worsening.3. Return to Work: 72 hours after symptoms are gone, and at

least 7 days have passed since symptoms first appeared.

4. Member’s prolonged close contacts do not require ROM.

Confirmed Case

1. Member placed in isolatio

precautions to avoid conta

2. Member to notify Unit pro3. Return to Work: 72 hours 

days have passed since s

4. Member’s prolonged close 

days.

Yes

Probable Case

1. Member placed in isolation at home / barracks / lodging, with strict

precautions to avoid contact with others and restrict outdoor activities.

2. Member to notify Unit provider or PCM if symptoms worsening.3. Return to Work: 72 hours after symptoms are gone, and at least 14 days

have passed since symptoms first appeared.

4. Member’s prolonged close contacts should be placed on ROM x 14 days

as operationally feasible as determined by Command.

No

Yes

Prolonged 

Close Contact with 

COVID-19 patient or 

Travel from high 

risk area.

No

Yes

Preventive Medicine and Operational Forces Medical Liaison to notify Command.

Meets 

case definitions for a 

Probable Case?

No

Yes

No

CASE DEFINITIONSConfirmed: Positive lab test with SARS-C

Serum detection of antigen or antibody d

Probable:

- Meets clinical description* with no alte

confirmed PCR test, AND one or more ebefore onset of symptoms. (Additional crdocument.)* Clinical description: Two of the followinsore throat, new olfactory, and taste diso(cough, shortness of breath, or difficulty evidence of pneumonia; OR acute respir
 DD FORM 689, AUG 2017 PREVIOUS EDITION IS OBSOLETE. Page 1 of 1

AEM LiveCycle Designer

INDIVIDUAL SICK SLIP

1. MEDICAL CONDITION (Brief Description) ILLNESS INJURY

COVID-19

2. DATE (YYYYMMDD)

3. PATIENT'S NAME (Last, First, Middle Initial)

4. DoD ID NUMBER 5. GRADE / RANK

6. ORGANIZATION AND STATION

UNIT COMMANDER'S SECTION

7. IN LINE OF DUTY

8. REMARKS

9. SIGNATURE OF UNIT COMMANDER

MEDICAL OFFICER'S SECTION

10. IN LINE OF DUTY

No (EPTS) Yes (EPTS)

11. DISPOSITION OF PATIENT

DUTY QUARTERS SICK BAY

HOSPITAL NOT EXAMINED OTHER (Specify:)

12. REMARKS

The above individual have be diagnosed with COVID-19. It is 

recommended that this individual remain in home isolation for 

at least 14 days from today AND 3 days after his/her recovery 

defined as resolution of fevers and improvement of illness 

symptoms without the use of symptom-altering medications. 

The Service member may return to work after completion of the 

period described above. Unless otherwise noted by the 

healthcare provider, no additional medical follow up is required.

13. SIGNATURE OF MEDICAL OFFICER

Enclosure 1