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Page 1 of 1

undertaking on Home Quarantine

' .......................... slwld Of resident of being home

quarantined, do hereby undertake to maintain home quarantine at all times for ...................... days (prescribed

period). During this period I shall monitor my health and those around me and interact with the assigned

surveillance team/with the call Center (104), in case I suffer from any detoriating symptoms or any of my

close family contact develops any symptoms consistent with COVID-19.

I have been explained in detail about the precautions that I need to follow while I am under quarantine.

I will abide by all guidelines/protocols/orders issued by the Health Department/District Authorities from time

to time. I am liable to be fined Rs 2,000 for non-adherence to the order of quarantine issued by the District

Magistrate, as provided u/s 7 of the Madhya Pradesh Epidemic Diseases, Regulation 2020. In case of

subsequent non-adherence to the order,I will be liable to be shifted to Quarantine Centre/CCC Center.

Additionally,I am liable to be acted under the prescribed law+ for any non-adherence to quarantine protocol.

*Prescribed Law

• The Madhya pradesh publicHealthAct,1949

• The DisasterManagementAct, 2005.

Name.................."............

Signature,.................„.......

Full Address and Contact Number:

®

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rfe i36] afro, ir, fgiv 23 nd 202O-air 3, ¥Iqr 1942

ds Hitap ¢ TRFT 5ffliuT faermrfu, iTEN ffl, fro

fro, fas 23 qri 2020

No. Psfflcalth/17/Medi-3/595- In exercise of the powers confened under Section 2, 3 & 4 of

The Epidemic Diseases Act, 1897, the Governor of Madhya Prndesh is pleased to issue the

following regulations regarding COVID-19 (Corona Virus Disease 2019)

I. These regulations may be called "The Madhya Pradesh Epidemic Diseases, COVID-19

Regulations, 2020.

2. "Epidemic Disease" in these regulations means COVID-19 (Corona Virus Disease 2019)

which has been notified as Notiried Epidemic disease and `CNotified Infectious Disease"

under Madhya Pradesh Public Health Act, 1949 by notification dated 18.03.2020.

3. Authorized persons under this Act are Principal Secretary (Public Health & Family

Welfare) at the State Level, District Magistrate, Commissioner of Municipal Corporation,

Sub Divisional Magistrate (SDM), Chief Medical and Health Officer and Civil Surgeon

cum Hospital Superintendent in the districts.

4. Staff of all Government Departments and Organization of the concerned area will be at

the disposal of the District Magistrate, Sub Divisional Magistrate (SDM), and officers

authorized by the Department of Public I+ealth and Family Welfare, for discharging the

dutyofcontainmentmeasuresinthedistricts.Ifrapuired,DisthctMagistratemayordp

requisition of services and facilities of any other person/institution.271

©

272 7]trfu -, fgiv 23 nd 2020

5. No persons/institution/organization will use any print or electronic or social media for

dissemination of any information regarding COVID-19 without ascertaining the facts and

prior clearance of the Principal Secretary ((Public Health & Family Welfare),

Commissioner, Health, Commissioner Medical Education, Director (Public Health &

Family Welfare), Director (Medical Education) or the District Magistrate as the case may

be. This is necessary to avoid spread of any unauthenticated information and/or rumors

regarding COVID-19. If any person/institution/organization is found indulging in such

activity,itwillbetrcatedasapunishableoffenceundertheseRegulations.

6. All hospitals, nursing homes and clinical establishments (government or private) during

screening of specified cases shall record the history of travel of the person to any country

or area (as per the guidelines issued from time to time by Government of India) where

COVID-19 has been reported. The history of contacts with the suspected or conflrmed

caseofCOVID-19isrequiredtoberecorded.Contacttracingforpatients(requiredasper

the guidelines issued from time to time) will be conducted by the Health Department or

by other identified staff. Information of all such cases must be given to District Integrated

Disease Surveillance Unit and District Magistrate immediately.

7. If the owner or occupier(s) of any premises or any individual suspected/confirmed with

COVID-19, refuses to take measures for prevention or treatment i.e., Home

Quarantine/Institutional Quarantine/Isolation or any such person refuses to co-operate

with, render assistance to, or comply with the directions of the Surveillance Personnel,

the concerned District Magistrate havingjurisdiction specifically in this regard, may pass

an appropriate order and may proceed with proceedings under Section 133 of the Code of

Criminal Procedure, 1973 (2 of 1974),

necessary and expedient

or take any other coercive action as deemed

for enforcing such cooperation

minor, such Order shall

and assistance. In case of a

be directed to the guardian or any other adult member of the

family of the minor.

8. All advisories issued/or to be issued by the Government of India on COVID-19 will ipso

facto be treated as directions under the Epidemic Diseases Act, 1897 in the State of

Madhya pradesh. `

9. With the conculTence of Health and Family Welfare Department, Madhya Pradest

District Disaster Management Committee headed by District Magistrate is authorized for

planning strategy regarding containment measures for COVID-19 in their respective

districts. The District Magistrate may co opt more officers from different departments for

District Disaster Management Committee for this activity under these regulations.

®

qtrfu {Trm=, fgiv 23 nd 2020 272 ( I)

10. Pemlty: Any person/institution/organization found violating any provisions of this

regulation shall be deemed to have committed an offence punishable under Section

187/188/269/270/271 of the Indian Penal Code (45 of 1860). District Magistrate of a

District may penalize any person/institution/organization if found violating provisions of

these regulation or any further orders issued by the Government under these Regulations.

11. Protection to persons acting under the Act: No suit or legal proceedings shall lie

against any person for anything done or intended to be done in good faith under this Act

unless proved otherwise.

12. These regulations shall come into force immediately and shall remain valid for a period

of one year from the date of publication of this notification.

By order and in the name of the Governor of Madhya Pradesh,RAIEEV CHANDRA DUBEY, Secy. .

fife, qTrfu B=ui den aen wh, 7"rfu gTIT uTch aTat Em5z], `frqTH a gil dan 9rfu-2020.

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©

OFFENCES AND PENALTIES FOR 'b7'i®L.ATl®N OF L®CKDOWN MEASURE

A. SECTION:§1-~T®.:cO OF THE DISASTEF"ANAGEMENT ACT, 2005

51. Punishment for obstr.uctiorl, etc -~Whoever without reasonable cai!se -~

(a) obstriicts any ofiicer ur erTiployee of the Cen'ii-al Governmerit o!- {ne StateGovernment` ol a pei'3on ,'=tuthonsea by the National Au{hority or Stai:e /\uthorlty

or District Authori[\,J in the ciistciiai.ge oi-his functions imder this Act. ot

(b) refuses to comply with any directlon given by or on behalf of the CentralGovernment or the State Government or the National Executive Committee orthe State Executive Committee or the District Authority under this Act,

shall on conviction be punishable with imprisonmen{ for a term whlch may extend

to one year or with fine or with both, and if such obstruction or refusal to comply

with directions results in loss of lives or imminent danger theret)i , sihall on

conviction be pumshable witn iiiipnsonment for a term whlch may exteiid to two

years.

52. Punishment for fa!stL± tc§airrl -Vvhoevel- know!ngl\/ niakes a claim which he

knows or has reason lc? beiie\,'e io i)e false for. ob{airilng any relief, assistance,

repalr. reconstriiction or cjtiier benefits conseqiienl {o disaster from ally officer of

the Central Governmeiii. t}-`Ie State Governmenl`, the National Authorit\/, the State

Authority or the Districi /`ulnority shall. on conviction be punishable with

imprisonment for a te!.in v`/hich n.lay extend to two \/ears` and also with fine

53. Punishment for rri.i.sapL`jpr®priation ®f momie`j;' cr materials, eta `-`V`v..hoever`

belng entrusted with any money or materials, tji c>lrlerwise beirig, Hi custody of, or

dominion over, any money oi-goods. mean for pro\7iding relief in any Lhreatening

disaster situation ar ciisasiei. misappropiiates or appi.opriates for hls own use or

disposes of such money c>i-materials or ally pall thereof or wilfully compels anyother person so to c!o siiall on f,onviction be punisnable with imprisonment for aterm which may extencl {o lvlto years. and also with flne.

54. Punishment for t-also t+t'arning.~Whoever liiakes cH` circulates a false alarmol-warriing as to disa.stei iji-'il.i .severity cjr magiii'iud€`, !eading` to pai`ic. shall c)ii

conviction, be punishable with in.iprisonment which may extencl to ;One year or

with fine.

55. Offences by Depaii:memEg ¢)f true Goveirr§men.i.-¢`l) Where an offence

under this Act has been comrrHtled by any Depar[nient of the Government, thehead of the Depanmeiit shall be cjeemed to be guilt}J ot. the offence and shall beliable to be proceeded agaii.`is.L ai.id piimshed accorc`jingly unless he prcjves that

1

Undertaking on Quarantine

l .....,.................. „s|vN|d Of resident of being home

quarantined, do hereby undertake to maintain home quarantine at all times for ..................... days (prescribed

period). During this period I shall monitor my health and those around me and interact with the assigned

surveillance team/with the call Center (104), in case I suffer from any detoriating symptoms or any of my

close family contact develops any symptoms consistent with COVID-19.

I have been explained in detail about the precautions that I need to follow while I am under quarantine.

I will abide by all guidelines/protocols/orders issued by the Health Department/District Authorities from time

to time. I am liable to be fined Rs 2,000 for non-adherence to the order of quarantine issued by the District

Magistrate, as provided u/s 7 of the Madhya Pradesh Epidemic Diseases, Regulation 2020.

Additionally,I am liable to be acted under the prescribed law* for any non-adherence to quarantine protocol.

*Prescribed law

• The Madhya pradesh publicHealthAct,1949

• The Disaster ManagementAct, 2005.

Name ..... _ ...... " ....... "." ... ' .

Signature...............„..........

Full Address and Contact Number:

®

Got.ernmiJnto1.India.\1inisti-\' til` I-]ealth & I.`amil\' \+.I.lt.ai.ii

Guidelines for Home Isolation ol` `'er\' mild/Ore-svliiptoinatic COVID-19 cases

I. Scope

Tlie presem guidelines are in additii>ii `o giiidi`lines on appropriatc` i"niigemeiit ijl` siispei`t,coiifinm]d i.asc`

of C`OVID-19 issued b}' Mol-IFW on 7"` f\iii.il. 2()20. All siispi`cti`d (ii\t.tiiting ti`sl ri`sults) ;inil i.onfii-mi`d

cases ot`COVID-19 disease al.e cui.I.el`tl.y bi'mg is`>l.iliJd aiid mai`agiid in a hos|)ital setting wilh the intent

t() b[.eak the chaiii {)t` tri`n.`iiiissi(7ii.

As pei. existing guidelines. duiing the coiitaiiiiiieiit phi\sc the patii`iits should be clinically assiglle(I as verylllild/mild. model.ate or sevi`rc and aci.orililigly admitted to (i) C`OV'lD Carl-C`cntei.. (ii) DedicatedCOVID Health Center oi. (iii) Dedic`ated (,`OVID Hospital respectively. However, ver}J mild/pi.e-symptomatic patients haviiig thi` I.eiiuisiti` fai`ility at hiszlier resicli`iii`i` r`or si`lf-isolation will havc` thi`

option foi. home isolatioll.

2. Eligibility foi. home isolation

i. The 1)ci.son should bi` i`liiiii.:`lI.\ i`s`it!Iii`J ii> `` \``r.\ milil i.i`si` I)ri`-`}Jmi)tomatii` i.asi` b}. the

treatiilg i`1eilii`al ol`l`icel..

ii. Such cases should hz`ve thi` reqiiisiti` l`i`i`ilily £`1 thi`ir I.esidc.ni`e l`or selt`-isolation :mJ i`l.so for

quarantiiiing the t`aiiii ly i.uiiti.`i`ls.iii. A cal.e giver should bc a\'ailabli` to pi.o\'ide i`ai.i` on 2+ .\7 l)asis. A i`ommiinii.alion link

between the .`ai.egi\er aml husi)ilal i` a I)rereqiiisiti. I`or the entire duration of home isitkition.iv. The care givei. .ind all i`losii i`iti-i`:ic`ts or sucli c€iscs shoiild t{`ke Hydroxychli>roqiiiiie

prophylaxis as per proloi`ol aiiil as pri`scribi`il by llie trc{iliiig mediciil ot`rii`er.v. Dowiiload Ai.ogya Setu Api) on mobili` (ii\aikibli` Lit: hoi)s: /\ww.mygo\.in/aarog.v{`-setii-

app/) and it shoiild remain aeti\ e {`t all timi.s ( lhrough Bluelooth :`iid W'i-Fi)

vi. The patient shall agree to moiiitoi. his hi`alth aliil ri`gularl.v int`oim his health slatiis lo thi`

District Survcillanee OfiiL`er l`oi. furlhi`r l`ollirv lip by thi` sui-\'eillani`L` teams.vii. The patient \\'ill fill in an undertaking oil sell`-isolation (Annexure I) and `shall l`ollt]\\` home

quarantine guidi.lines. Siicli iiidi\'iduiil shi`ll bi. cligibli. for home isolatioii.viii. Ii"iddition to the guidelini`s oil hoini`-ciilarai`line a\':iihbli"I:

https:,``;'ww\\'.mohfw gii\/'.in r]dr GiHdi`lini.``I`iH.li{jmi'iiuaraiitHii`.I.il[`. ihi. I.i`iiiiii.ed ilistriii`ti{tiis roi.

the i`are gi\Jci. aiid {Iie p{`lii`nt i`s in ,\iini`,`iiri.11 sli:Ill bi` iil`o l`ollowed.

3. When to seek medic`al attention

Patieiit J Cai.e giver will keep monitoring thcir lie.iltli. Immediali. medii`al attention must lii` sought il`

sc`rious signs or symptoms dc\'clo|). Tlicsc could ini`liidc

(i) DifficiLlty ill brcathiiig,

(ii) Persistent painJpressilfe ill tlie i`he>;t.

(jii) Mental coiil`iision oi. im`bilit.\' ti) aroiise.

(i\) De\'eloping b]uisli ilisi.ttliti':LliitiN `ti`lii)i I`ai`i` iinil

(\J) As ad\'ised bv trl.atmg ml.ilii``il ofrii`ei.

4. When to discolitinue honii` isolatioii

Patients under home isolation will i.nd hiimi. isulalion ir symptoms arc i`liliically. 1.esol\'i`d imd thi`surveillance medii`al officei. i`ertifies him ti> bi` t`i.i.i. ot` il`fei`tion at`ter laboi.atoi..y testing

©

Anll,,xllre I

|Tndei.(aking on self-isolation

S/W ol` ..... resideiil ot`

biiiiiLg (liiigiiose(I as a i`oiifirmi.d,siispci`t i`ase of (`Ovlr)-19. do

hereby voluntarily undeiliike to i"iili(iLili `trii`l Lil.ll`-I``iihtioii i`t i`II tiilie` t`or the prescribed pi-I.iod.

DIIling this peL.iod I shall moiiiti)I. I)I.\. h.i\lLli .iiiil Lhi)se ari>uiid i`il` iHiil illti`I.iict \\ith thi` {```LiiJiieJ

surveillance teanvwith the call i`eiiter ( 1075). in i`{ise 1 siift`er from any (1etei.iorating symploim oi. any

of my close faiiiily coiitacts tle\'elt>ps iin}J s}tmptoms consisti`nt with C`OVID-I `J.

I 11avi` bi`cn cxplaincd in di`tail abuiiL thi` p]-i'i`iiiiliijiis tl`zil I tii-i`d tu l`ulluw w]ijli] I am iiliilcr si]ll`-

isolatioll.

I am liable to bc acted on under thi` I)ri`sciilii`d ki\\' foL. {iliy iioii-adhi`i.i`Licc to sclt`-isolzition I)roti>i`ol.

(`onl{ic`t Niiinber

CE9

Annt`xure I IInstructions for care-givers

• Mask: The caregiver should \vear a tri|ile layer medii`al mask ai)I)ropriately when in thi. same

room with (hc ill pci.son. Fi.oiit poi.tion ol` thi` i"isk slioiilcl iiot bi` toiLi`hed oi. handled diLriiig iise. Jf

the mask gets \\Jet or dii.ty \\'ith `seci.etii>ns` il miist be chitnged immediatel).. Discal.d the mi`sk after

use and perform hand h.ygiene afli'i. disiii)s{`I itl`tlii. mash.• He/she sliould avoid toiii`hing ou'ii l`ai`e` nosi. oi. moutli.

• Hand hygiene must be ensin.ed l`iilluwiiig i`iM"i`t with ill r7ei.so]i oi-his iiiimedii`te enviroiiment.

• Hand hygieiie shoiild also be imii.tii`cil before imd €ifter pri.I)iiring l`ood, befoi.e eating. afti.r usiiig

the toilet. and whilie\Ji`r hands li)ok dil.t.y. IJ'Si` soap €ind wati`r for hand w<1shing at le.ist for 40seconds. Alcohol-based hand I.lib i`.in bi` iisi`d. it` hands are iiot visibl.v soill`d.

• After using soap and \\Jatcr. usi` ot` disposiibli` I)apcr towi'1s to di.y han(ls is dcsiral)1e. It` not

available. use dedicalcd cli`an clotli to\\'i`ls and ri`place tlii`m whi`n thi`y becoiiie wet.• Exposure to patient: A\Joid ilil.ci`t i.oiilai`t wi(li body lliiids \)1` (hi` piitii`iil. particiilarl}' ural or

respiratol.y sccrctioiis. Ij'se ili`i)o.`abli. gl`t\.i`s \\hili` haiidliiig tlli` paticiit. PiT1`omi llalld h.ygieni`

bel`ore and arler removing glo\ i`s.• Avoid exposure to polenLially conlaminated i(ems in his immediate environment (e.g. a\'oid

sharing cigaL.ettes, eating utensils. dishes. di.inks. iised towels oi. bi-d liiicn).• Food must be provided to tlie patieiit ill his ri>om

• Utensils and dishes used by llie iiiitieiit shoiild be c`leaned witli soaptde`ergeiil dlid walei. weal.ing

gloves. Tlic utensils ant dislic`s m{i.y be 1.i`-iised. C`lean hands iifli`r taking ot`f` glo\Jcs or handlingiised items.

• Use triple layer medical i"sk alid disr}osaL)Ii. glo\'es wliili` i`li`i`niiig i7r haiidliiig ``iirl`i`i`cs,

i`lothiiig or lilli.n iised b}' thi. piitii'iil. Pi`rl`itl-in li.iiiil hygii.ni' liel`ili.i' ;iiiil after I-I.mi)\'inL¥ glu\ i`>.

• Tlic cai.e gi\.i`i. will maki` sui.e tliiit llii` I)iitii`m I.ollit\\s tlii` pri'sci.Ibi`{l ti.i`atliii`iit.

• The care giver aild all closi` i`oiitact \+ill self-monitor thi`ii. health \\Jith daily temi)eraturc

lnonitoring and report promptl.\ it` lhe} ile\Jelop ally syiiii)tom sugge`sti\z'e of` CO\'lD-19

(fever/cough/difi`icillty in breathing)

Instructions for the patient

• P£`ticnt should at all times iisi` ti.ipli` I:`ycr mcdii`{`l I"isk. Disci`rd im`sk aflcr 8 hours iir iise or

earliei. if the.y become \`.et or vi``ibly si)ill-d.• Mask should be discarded only al`tei. (lisiiifi`cliiig it with l°/a So(lium Hypit-clili>ritc.

• Patient must stay in the identirled room and Li\\.{iy from other pi`ople in home. espei`ially i`1del.lies

and those witli i`o-morbid comlilioiis liki` li.viiei.teiision. i`zirdio\Jdseiikii. disi`ase` rcmil discasi` i`tc`.

• Patii`nt niusHaki` rest and diink li" i)I` lliiidh tii iiiiiintLiimdi`iiii.iti` li}ill.atioil

• Follow respirator}I' ctiquetti`s all tlii` tlmi`

• Hands must bc washed ol`ti`n \\ith sijzi|) ;-Hiu \\ati`i. fiti. at li`ast iu si`i`onds ()r i.1i`an with alc`ollol

based saniti7,c`r.

• Doii`t shai.e pii.som`l items uJitli othi`i. pi`i)pli`.

• C`1ean surfaces in the room th:it .ire loiic`hi`cl ot`ten (t<ibli`tops` door kliobs. hzmdles. i`tc) with 1°'o

hypoi`hlorite solution.• The patient must stric`tly follour the pllysiiiaii`s instructit)ns ancl mcdicatioll advice.

• The patient will s.`lt`-monitoi. his/hci. healtli witli daily tcmpci.atiirc monitoring and report promptly

if develoi)s any deteiiorfitioii o]` `symptom iis deujll`d bi.lou .