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SYMPTOM SCREENING FORM Patient name:Measured temperature:Date of birth:(must be below 100.4)Flulike symptoms (fever, muscle aches): Yes Borough: Yes Shortness of breath: Yes Direct exposure to person(s)
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Who needs 4497 csymptom screening formindd?
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What is 4497 csymptom screening formindd?
4497 csymptom screening formindd is a form used to screen for symptoms related to a specific condition.
Who is required to file 4497 csymptom screening formindd?
Anyone who is suspected of having the specific condition is required to fill out the form.
How to fill out 4497 csymptom screening formindd?
The form should be filled out by providing information about any symptoms experienced and any relevant medical history.
What is the purpose of 4497 csymptom screening formindd?
The purpose of the form is to help identify individuals who may have the specific condition and to provide appropriate care.
What information must be reported on 4497 csymptom screening formindd?
Information about symptoms experienced, medical history, and any other relevant details must be reported on the form.
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