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Which, if any, of the following symptoms are you experiencing? *
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Have you been exposed to COVID-19 or traveled to a high risk location within the past 14 days? *
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Are you a health care worker or do you work in a health care setting? i.g. Acute care hospitals, Physicians' offices, Long-term care facilities (e.g., nursing homes, skilled nursing facilities, etc.), Urgent care centers, Outpatient clinics or centers, Emergency medical services, Home healthcare (i.e., care provided at home by professional health care providers) or Other medical clinics (including medical sites within non-healthcare settings such as in a school, dormitory, shelter, or prison). *
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Are you the primary caretaker of family members and/or friends? *
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Have you received the COVID-19 vaccine? *
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Which of the conditions below apply to you? *
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Which, if any, of the following symptoms are you experiencing?
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Have you been exposed to COVID-19 or traveled to a high risk location within the past 14 days?
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Are you a health care worker or do you work in a health care setting? i.g. Acute care hospitals, Physicians' offices, Long-term care facilities (e.g., nursing homes, skilled nursing facilities, etc.), Urgent care centers, Outpatient clinics or centers, Emergency medical services, Home healthcare (i.e., care provided at home by professional health care providers) or Other medical clinics (including medical sites within non-healthcare settings such as in a school, dormitory, shelter, or prison).
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