Mark Medical Care - COVID 19 Health Screening
The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic. Due to its capacity to transmit from person-to-person through respiratory droplets, the government has set recommendations, guidelines, and some prohibitions which Mark Medical Care (the “Organization”) adheres to comply.

Employee/Visitor Health Screening
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Date *
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Location *
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Have you experienced a fever of 100.4 degrees Fahrenheit or greater, a new cough, new loss of taste or smell or shortness of breath within the past 10 days? *
Required
In the past 10 days, have you tested positive for COVID-19 using a test that tested saliva or used a nose or throat swab (not blood test)? (10 days measured from the date you were tested, not the date you received the test result,) *
Required
To the best of your knowledge, in the past 14 days have you been in close contact (6 feet for at least 10 minutes) with anyone while they have had COVID-19? *
Required
In the past 14 days, have you traveled internationally or returned from a state identified by New York State as having widespread community transmission of COVID-19 (other than just passing through the restricted state for less than 24 hours)? Visit https://coronavirus.health.ny.gov/covid-19-travel-advisory for applicable stated *
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Your Name *
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