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COVID-19 Questionnaire

Are you at risk?

Do you have a fever AND respiratory symptoms like cough or shortness of breath?

Have you had close contact with a person infected with COVID-19 or history of travel to an affected geographic area?

Are you over 65, pregnant, or have a chronic lung condition, heart disease, diabetes, or on an immune suppressive medication?

Are you having difficulty breathing, unable to eat or drink, or too weak to care for yourself?

Practice Hand Hygiene and Respiratory Etiquette

  • If you do leave your home to go to a care facility, wear a mask so your coughs and sneezes are less likely to infect others. (Masks are NOT recommended for healthy people in the general population.)
  • Wash your hands thoroughly (for at least 20 seconds) after sneezing, blowing your nose, coughing or using the bathroom, and before preparing or eating food.
  • If you cough or sneeze, do so into the bend of your elbow, not your hand. Or use a tissue, and then throw it away immediately afterward.
  • At home, clean often-touched surfaces such as doors and doorknobs, cabinet handles, bathroom hardware, tabletops, phones, tablets and keyboards regularly with disinfectant.

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