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COVID-19 self diagnosis

Do you have or have had respiratory symptoms related to breathing in the past week?
Yes
No
Do you have or have experienced fever in the past week?
Yes
No
Do you have or have experienced cough (dry or wet) in the past week?
Yes
No
Did you travel to any COVID-19 affected countries in the past 14-28 days?
Yes
No
Did you have any serious illnesses in the past or have any currently?
Yes
No
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