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DES MOINES, Iowa – A blank document from the Iowa Department of Public Health has been discovered online, designed to be filled in with the name of an H1N1 virus victim who is required to relocate from his or her home to a quarantine facility.

The form, which began appearing today in e-mails and on the Internet, has concerned a confused public already swimming in conflicting reports about the severity of the swine flu and intrusive government measures that many fear may be taken if the disease becomes a pandemic.

The Iowa document, which WND confirmed with state officials is authentic, has done little to calm the public’s fears.

“The Iowa Department of Public Health has determined that you have had contact with a person with Novel Influenza A H1N1,” the form reads. “The Department has determined that it is necessary to quarantine your movement to a specific facility to prevent further spread of this disease.

“The Department has determined that quarantine in your home and other less restrictive alternatives are not acceptable,” the document continues, before listing mandatory provisions of compliance with relocation to a quarantine facility.

The blank-form document, which has no name or case number listed, is titled a “Facility Quarantine Order,” and though Iowa Department of Public Health Medical Director Patricia Quinlisk confirmed the state has the form, she told WND it’s highly unlikely it will ever be used.

“We’ve had these kinds of template orders for years, but we hardly ever use them,” Quinslick said. “I can count on two hands the number of times – in 20 years – that we’ve had to relocate a person because of quarantine.”

Quinslick wasn’t certain who released the blank document, or who signed her name to the bottom of some versions circulating on the Internet, but she wasn’t concerned that it’s been made public.

“We’re not trying to hide anything,” she said. “This is the kind of form we use.”

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Quinslick told WND her department has prepared similar documents for several contagious diseases to “have them ready just in case.”

But at the same time, she said, state law requires that when IPDH does need to quarantine someone, it be done in the least restrictive way possible, which typically means in the person’s home.

“Usually when we relocate, it’s only because they have no place to be, like a homeless tuberculosis patient,” Quinslick said, “One time, I recall, we relocated a homeless man to his relative’s house.”

The Facility Quarantine Order for the H1N1 virus that has been circulated online illustrates Quinslick’s point.

Following the order that a person be removed from his or her home, the form contains a blank for explaining the reason, including one of the following: “the person violated a previously issued home quarantine order, the person does not have an appropriate home setting conducive to home quarantine, etc.”

Quinslick told WND it was doubly unlikely the state would use the form, since the swine flu has proven less dangerous than earlier estimates.

“I don’t anticipate using [the form] for H1N1, since it’s been shown to be a very mild disease,” Quinslick said. “We found this spring it’s not as serious as feared.”

As for fears that Iowa is preparing detention centers for rounding up the people who refuse swine flu shots, Quinslick was quick to dismiss the idea.

“Iowa has no relocation facility currently,” she said. “If we can’t quarantine a person in their home, we usually use a hotel room. There’s not a facility, no gymnasium or anything like that set up.

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“And I’ve never been in on any discussion of forcing people to be vaccinated,” she added. “If there’s a highly contagious outbreak and a person refuses vaccination, that’s fine, they don’t need to be vaccinated, but they may need to stay home until we’re certain the danger has passed.”

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