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(828) 8371005 (828) 8371050Carolina Smiles114 Buttercup Trainable, North Carolina289059144USA carolinasmiles@frontier.comFeb 17, 2021Covid19 Risk Form First name The Patientest name PatientxxOur goal is to provide a safe environment for our patients & staff, and to advance the safety of our local community. As your dental care provider, were following all Federal, State and Local Government guidelines.
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Start by providing your personal details such as name, contact information, and date of birth.
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Fill out details about your current health status, including any symptoms you may be experiencing.
03
Answer questions about your recent travel history and any close contact you may have had with individuals who tested positive for COVID-19.
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Declare any pre-existing health conditions or vulnerabilities that may put you at higher risk for contracting COVID-19.
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Review all information provided for accuracy before submitting the form.

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Anyone who is required to undergo health screening or risk assessment related to COVID-19 may need to fill out a COVID-19 risk form. This can include employees, students, patients, travelers, and individuals participating in social gatherings or events.
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The COVID-19 risk form is a document used to assess and report the risk of COVID-19 exposure in a particular setting.
Employers, event organizers, and other organizations may be required to file the COVID-19 risk form depending on local regulations and guidelines.
The COVID-19 risk form can typically be filled out online or on paper, and will require information about the location, number of individuals present, safety measures in place, and any known COVID-19 cases.
The purpose of the COVID-19 risk form is to assess the risk of COVID-19 exposure in a specific setting, implement necessary safety measures, and prevent the spread of the virus.
Information such as the location, number of individuals present, safety measures in place, and any known COVID-19 cases must be reported on the COVID-19 risk form.
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