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Have you or a member of your household had any of the following symptoms in the last 21 days: sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, loss of smell, loss of taste, fever, temperature at or greater than 100 degrees Fahrenheit?

Have you or a member of your household been tested for COVID-19?

Have you or a member of your household been advised to be Tested for COVID-19 by government officials or healthcare providers?

Were you or a member of your household advised to selfquarantine for COVID-19 by government officials or healthcare providers?

Have you or a member of your household visited or received treatment in a hospital, nursing home, long-term care, or other healthcare facility in the last 30 days?

Have you or a member of your household traveled outside the U.S. in the past 30 days?

Have you or a member of your household traveled elsewhere in the U.S. in the past 21 days?

Have you or a member of your household traveled on a cruise ship in the last 21 days?

Have you or a member of your household cared for an individual who is in quarantine or is a presumptive positive or has tested Positive for COVID-19?

Do you have any reason to believe you or a member of your household has been exposed to or acquired COVID-19?

To the best of your knowledge have you been in close proximity to any individual who tested positive for COVID-19?

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