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First Point of Contact Screening Patient Name___ Date___ Please print full legal name are committed to providing the safest environment for our patients. Please complete the questionnaire below. If
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Individuals who are required to undergo screening for COVID-19 as part of a first point of contact assessment
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1stpointofcontactscreeningcovid19pagespdf is a document used for screening individuals at the first point of contact for COVID-19 symptoms and exposure.
Individuals or organizations conducting health screenings for COVID-19, such as healthcare facilities, employers, and event organizers, are required to file this document.
To fill out the document, provide the necessary personal details of the individual being screened, answer health-related questions regarding COVID-19 symptoms and exposure, and sign the document if required.
The purpose of the document is to assess the health status of individuals for COVID-19 to prevent its spread, ensuring safety in public and private settings.
The document requires reporting personal identification information, health screening responses related to COVID-19 symptoms, recent travel history, and any known exposure to infected individuals.
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