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Novel Coronavirus (COVID19) Screening Questionnaire Patient Name: ___DOB: ___Please Circle YES or NO to the following question 1. Do you, any member of your household, or anyone traveling with you
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It is a form used for screening individuals for COVID-19.
Anyone who needs to be screened for COVID-19 or who is required to report screening results.
Fill out the form with accurate information related to COVID-19 symptoms, exposure, and other relevant details.
The purpose is to identify individuals who may have COVID-19 and take necessary precautions to prevent its spread.
Information such as symptoms experienced, exposure to confirmed cases, travel history, and contact information.
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