We conducted an outbreak investigation at St. Francis Hospital, the only referral hospital in Rivercess County that provides free healthcare services including treatment and care for COVID-19. We constructed a case definition, conducted an active case search, line listed and followed up with contacts and instituted case management and infection prevention and control system in the hospital. Demographic, epidemiological, and clinical information of the confirmed case and suspected cases were extracted from the COVID-19 line list for Rivercess County and analyzed.