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 or diarrhea, ageusia, anosmia within the past 14 days? |
YES or NO |
3. Have you, within the past 14 days, travelled to risk areas or visited a neighborhood 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 unacquainted people? |
YES or NO |