In the past 24 hours, have you had any of the following: *
Yes
No
A new fever (100.4 or higher) or a sense of having a fever?
Taken medication to reduce a fever?
A new cough that you cannot attribute to another heath condition?
New shortness of breath that you cannot attribute to another health condition?
A new sore throat that you cannot attribute to another health condition?
New muscle aches (myalgia) that you cannot attribute to another health condition or that may have been caused by a specific activity (such as physical exercise)?
A new onset of loss of sense of taste or smell?
Nausea or vomiting?
Diarrhea?
Congestion or runny nose?
Have you been around someone who is sick?
Have you been around someone who has tested positive for COVID-19?
Yes
No
A new fever (100.4 or higher) or a sense of having a fever?
Taken medication to reduce a fever?
A new cough that you cannot attribute to another heath condition?
New shortness of breath that you cannot attribute to another health condition?
A new sore throat that you cannot attribute to another health condition?
New muscle aches (myalgia) that you cannot attribute to another health condition or that may have been caused by a specific activity (such as physical exercise)?
A new onset of loss of sense of taste or smell?
Nausea or vomiting?
Diarrhea?
Congestion or runny nose?
Have you been around someone who is sick?
Have you been around someone who has tested positive for COVID-19?
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