Contact
Full Name
Role
Do you meet any of this criteria?
  1. New cough
  2. New difficulty breathing
  3. New loss of taste or smell
  4. Two or more of the following symptoms:
    1. Fever above 100F or feeling feverish (chills, body aches)
    2. Vomiting or diarrhea
    3. Loss of appetite
    4. Unusual fatigue
    5. New rash on fingers or toes
  5. Contact in the past week with someone who has a fever, new cough, shortness of breath, or has been newly diagnosed with COVID-19 (do not include contact as part of direct patient care with appropriate PPE).