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. 2020 Apr 27;58(6):687–691. doi: 10.1016/j.bjoms.2020.04.025

Table 3.

Screening questionnaire.

1. Do you have fever or have you experienced fever within the past 14 days? YES or NO
2. Have you experienced a recent onset of respiratory problems, such as a cough or difficulty in breathing within the past 14 days? YES or NO
3. Have you, within the past 14 days, travelled to risk areas or visited neighborhoods with documented 2019-nCoV transmission? YES or NO
4. Have you come into contact with a patient with confirmed 2019-nCoV infection within the past 14 days? YES or NO
5. Have you recently participated in any gathering, meetings, or had close contact with many people you are not acquainted with? YES or NO