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. 2020 Oct 9;17(20):7365. doi: 10.3390/ijerph17207365

Table 1.

COVID-19 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 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