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COVID Screening Questions
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Triangle Kids is now Smile First Dental
Patient(s) name:
Name of the person who is bringing the child to the appointment:
Have or had a fever over the last 14 days?*
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Have or had shortness of breath over the last 14 days*
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Have or had a dry cough over the last 14 days?*
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Have or had any other flu-like symptoms over the last 14 days?*
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Have or had experienced a recent loss of taste or smell over the last 14 days?*
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Had any contact or proximity with any that has or had any of the above symptoms?
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Have traveled to any foreign country within the last 60 days?*
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Had any contact or proximity with any confirmed COVID-19 positive people?*
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