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Patients Covid Screening Questions
Patients Covid Screening Questions
Hunt Jeong
2022-06-17T01:35:08+12:00
Patients Name
(Required)
Appointment Date
(Required)
DD slash MM slash YYYY
Do you or any member of your household have COVID or are you waiting for a covid test result?
(Required)
Yes
No
Are you required to self-isolate?
(Required)
Yes
No
Have you developed ANY of the following symptoms in the last 4 days?
Fever, cough, shortness of breath
Muscle aches, loss of smell, sore throat
Generally feeling unwell with no other likely diagnosis
None of the above
Do you have any other reason to think that you are at risk of having COVID?
(Required)
Yes
No
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