SELECT ONE

       

Have you been exposed to someone who has tested positive with Covid in the last two weeks?

       

Have you been exposed to someone who has tested positive with Covid in the last two weeks?

     

Are you or anyone in your household waiting for test results for COVID19 (PCR, nose or mouth swab)?

     

Are you or anyone in your household waiting for test results for COVID19 (PCR, nose or mouth swab)?

     

Are you experiencing any of the following symptoms:

Headache

    

Cough, congestion, runny nose or sore throat

     

Any fever or chills within the last 72 hours

    

Fatigue

    

Difficulty breathing

    

Nausea / vomiting / diarrhea

    

Muscle aches / body aches

    

Change in taste or smell

    

Are you experiencing any of the following symptoms:

Headache

    

Cough, congestion, runny nose or sore throat

     

Any fever or chills within the last 72 hours

    

Nausea / vomiting / diarrhea

    

Difficulty breathing

    

Fatigue

    

Muscle aches / body aches

    

Change in taste or smell

    

PASS

PATIENT:


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