Health Screen For Adults
| 1. Do you have a fever or have felt hot or feverish in the past 14-21 days? |
| 2. Are you having shortness of breath or other difficulties breathing? |
| 3. Do you have a cough? |
| 4. Do you have any orther flu-like symptom like gastrointestinal upset, headaches, or fatigue? |
| 5. Have you experienced any recent lost of taste or smell? |
| 6. Have you or any family members been in contact with any COVID-19 positive patients? |
| 7. Do you have heart disease, lung disease, kidney disease, diabetes, or any auto-immune disorders? |
| 8. Have you traveled to any regions heavily affected by COVID-19? |
Notes:
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