Application for Record for Persons Infected with Coronavirus Disease 2019 (COVID-19)
Submission
* Questions that are required to be answered
Surname *
Given Name *
Please use the name that is identical to your personal identity document If your name cannot be separated into "Surname" and "Given Name", please enter your full name in the "Surname" field. The name will be printed on the document. Please fill in carefully.
Sex *
Male
Female
Date of Birth *
If birth year is available only, please fill in 1st January of corresponding year.
Only birth year is valid in above question about date of birth? *
Any attempt with date of birth outside of 1st January will be regarded as valid date of birth.
Yes
No
Mobile No. *
Please provide a phone contact that can receive SMS
Identity Card / Other Travel Document No *
Please enter all letters and numbers of the HKID number but not the brackets (i.e. A123456(7) please enter A1234567)
Type of Test *
Rapid Antigen Test (RAT)
Nucleic Acid Test (PCR)
Test Positive Date（or Specimen Collection Date） *
Email address
Request for amendment to isolation order due to wrong information? *
