Georgia Mass Antibiotic Distribution

Screening Instructions

Click "Add Next" button below, provide your name, and answer both questions. Click "Save."

1. Repeat step 1 for each person in your household.
2. When you have entered information for all household members, enter your ZIP code in the space under "Point of Distribution."
3. Click "Submit."
4. A PDF file will generate. This form must be printed or saved to a mobile device and brought to the distribution site. Only one person listed on the file needs to go to the POD to pick up the medications for the household members listed.
5. Each person registered will receive one of two medications, ciprofloxacin or doxycycline, during the initial phase of distribution. In some cases, a person will be referred for a medical consultation prior to receiving medication.  During the second phase each person registered will receive one of three medications, ciprofloxcin, doxycyline, or amoxicillin or be referred for a medical consultation.

If you are unable to get to a POD and do not have someone to help you, call your local public health department for help.

If you or anyone else experiences any side effects from the medication, call your local public health department or the FDA Adverse Event Reporting System at 1-855-543-3784.

Please note: No personally identifiable information is retained on this system once a completed form is displayed back to the user. It is possible your local machine, as with any website, may store some cached data and/or if you download the PDF form, your computer may maintain a copy. Aggregate ZIP code level responses to screening questions and medication choices are stored and available only to public health officials with authorized access to this information.