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Section 1 of 3
OPMS Daily Home Screening for Students / OPMS Evaluación de inicio diaria para estudiantes
Parents/Guardians: please complete this short checklist each morning prior to your student leaving for school. / Padres: por favor complete esta breve lista de verificación cada mañana antes de que su hijo se vaya a la escuela.
First and Last Name of Student / Nombre y apellido del estudiante
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Grade Level / Nivel de grado
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7th
8th
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Section 2 of 3
Section 1: Symptoms /Sección 1: Síntomas
If your child has any of the following symptoms, that indicates a possible illness that may decrease the student's ability to learn and also put them at risk for spreading illness to others. Please check your child for these symptoms: / Si su hijo tiene alguno de los siguientes síntomas, eso indica una posible enfermedad que puede disminuir la capacidad del estudiante para aprender y también ponerlo en riesgo de transmitir la enfermedad a otros. Por favor revise si su hijo tiene estos síntomas:
Temperature of 100 degrees Fahrenheit or more / Temperatura de 100 grados Fahrenheit o más
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Yes / Si
No
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Sore throat / Dolor de garganta
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Yes / Si
No
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add "Other"
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New uncontrolled cough that causes difficulty breathing (for students with chronic allergic/asthmatic cough, a change in their cough from baseline) / Nueva tos incontrolada que causa dificultad para respirar (para estudiantes con tos crónica alérgica / asmática, un cambio en su tos desde el inicio)
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Yes / Si
No
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Diarrhea, vomiting, or abdominal pain / Diarrea, vómitos o dolor abdominal
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Yes / Si
No
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add "Other"
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New onset of severe headache, especially with a fever / Nueva aparición de dolor de cabeza intenso, especialmente con fiebre.
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Yes / Si
No
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New loss of taste or smell / Nueva pérdida del gusto u olfato
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Yes / Si
No
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Congestion or runny nose / congestión o secreción nasal
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Yes / Si
No
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add "Other"
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Section 3 of 3
Section 2: Close Contact/Potential Exposure / Sección 2: Contacto cercano / Exposición potencial
Had exposure to someone with COVID-19 within the past 10 days OR lives with someone who has tested positive for COVID-19 / Tuvo exposición a alguien con COVID-19 en los últimos 10 días O vive con alguien que dio positivo en la prueba de COVID-19
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Yes / Si
No
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First and Last Name of Student / Nombre y apellido del estudiante
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Grade Level / Nivel de grado
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Section 1: Symptoms /Sección 1: Síntomas
Temperature of 100 degrees Fahrenheit or more / Temperatura de 100 grados Fahrenheit o más
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Sore throat / Dolor de garganta
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New uncontrolled cough that causes difficulty breathing (for students with chronic allergic/asthmatic cough, a change in their cough from baseline) / Nueva tos incontrolada que causa dificultad para respirar (para estudiantes con tos crónica alérgica / asmática, un cambio en su tos desde el inicio)
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Diarrhea, vomiting, or abdominal pain / Diarrea, vómitos o dolor abdominal
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New onset of severe headache, especially with a fever / Nueva aparición de dolor de cabeza intenso, especialmente con fiebre.
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New loss of taste or smell / Nueva pérdida del gusto u olfato
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Congestion or runny nose / congestión o secreción nasal
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Section 2: Close Contact/Potential Exposure / Sección 2: Contacto cercano / Exposición potencial
Had exposure to someone with COVID-19 within the past 10 days OR lives with someone who has tested positive for COVID-19 / Tuvo exposición a alguien con COVID-19 en los últimos 10 días O vive con alguien que dio positivo en la prueba de COVID-19
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