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YesNo
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
YesNo
Have you tested positive for Covid-19 ?in the past 14 days
Have you had close contact with with a confirmed or suspected Covid-19 casein the past 14 days?
Have you traveled within a state with significant community spread of Covid-19 for longer then 24 hours within the past 14 days?