Additional Recommended COVID-19 Questionnaire
Please answer the questions truthfully.
Regardless of your vaccination status, have
you experienced any of the symptoms?
• Fever or Chills
• Shortness of Breath or Difficulty Breathing
• Muscle or Body Aches
• New Loss of Taste or Smell
• Sore Throat
• Congestion or Runny Nose
• Nausea or Have you been in close physical contact in the last 10 days with anyone who is known to have COVID-19?
IMPORTANT: ANSWER “YES” EVEN IF YOU BELIEVE THE SYMPTOM(S) IS BECAUSE OF SOME OTHER MEDICAL CONDITION (FOR EXAMPLE, ANSWER “YES” IF YOU HAVE A RUNNY NOSE BECAUSE OF ALLERGIES).
If you have answered yes to any of these questions, further investigation of infection is recommended.
Utilizing a PCR test is recommended for verification of possible infection.
or contact your health care provided for PCR testing nearest to you
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