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COVID 19 QUESTIONAIRE
have you travelled outside the contry during the past 14 days
yes
no
have you been in close contact with anyone who has been outside the country during the past14 days
yes
no
Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?
yes
no
Have you experienced any cold or flu-like symptoms in the last 14 days (to include fever, cough, sore throat, respiratory illness, difficulty breathing)?
yes
no
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