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."