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Please answer for the last 2 weeks.
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Have you been diagnosed with COVID-19?
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Have you traveled anywhere outside of the US in the last 30 days?
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Where?
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Have you had a fever or felt feverish?
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Have you had shortness of breath or difficulty breathing?
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Have you had a cough?
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Have you had chills or repeated shaking with chills?
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Have you had a sore throat?
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Have you had a headache?
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Have you had a loss of taste or smell?
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Have you had an upset stomach, nausea, or diarrhea recently?
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Have you had any other flu-like symptoms like congestion, runny nose, body/muscle aches?
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Have you had any contact with anyone who has been confirmed to be COVID-19 positive and not wearing protective gear?
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Are you over the age of 65?
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Do you have heart disease?
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Do you have lung disease?
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Do you have kidney disease?
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Do you have Diabetes?
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Do you have Autoimmune disorders?
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