COVID-19 Screening
In addition to confirming a temperature under 100.4° F (38° C), the following screening must be completed on behalf of each provider at the beginning of each workday and on behalf of the caregiver prior to each in-person visit beginning July 1, 2021.
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First Name: *
Last Name: *
Have you or anyone in the home experienced any of the following symptoms in the past 48 hours?
Have you been in close physical contact in the last 14 days with anyone known to have symptoms of COVID-10 or tested positive for COVID-19? *
Are you or anyone in the home isolating or quarantining because you tested positive for COVID-19 or are you worried that you may be sick with COVID-19? *
Are you or anything in the home currently waiting on the results of a COVID-19 test? *
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This form was created inside of Blind Early Services TN.