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COVID 19 SCREENING FOR CLINICIANS.
*
Indicates required field
Name
*
First
Last
Do you have a new cough?
*
Yes
No
Do you have a new shortness of breath?
*
Yes
No
Do you have a fever (100.4 or higher)?
*
Yes
No
DO YOU CURRENTLY HAVE ANY OF THESE SYMPTOMS?
CHECK ALL THAT APPLY
*
fatigue
congestion or runny nose
sore throat
headache
new loss of taste or smell
diarrhea
muscle or body aches
nausea or vomiting
NONE OF THE ABOVE
Have you been in close contact (within 6 feet for more than 15 minutes) with someone who has received a laboratory tested diagnosis of COVID 19 in the past 14 days?
Close Contact
*
Yes
No
BY CLICKING SUBMIT I AM CERTIFYING THAT THE ABOVE INFORMATION IS ACCURATE TO THE BEST OF MY KNOWLEDGE.
Submit
HOME
WIG
TEAM STATS
INDIVIDUAL STATS
OPPORTUNITIES
Links
Family Tree Stories
HFT Blog
HFT Resources
Mandated Reporter Portal
Paylocity
PHFSO Dashboard
PHFS Events
PHFS Website
TIC Training Website