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BIAV COVID-19 Questions
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1.
Name
(Required.)
*
2.
In the past 48 hours have you had:
a. Any cough, shortness of breath, difficulty breathing, or new loss of taste/smell?
b. Fever of 100.4 or higher, chills, or body aches?
c. Headache, sore throat, GI symptoms (e.g. nausea/vomiting/diarrhea), or runny nose/congestion?
d. Have you had a positive COVID-19 test in the last 10 days?
e. Are you waiting on a COVID-19 test result for reasons other than pre- procedure/surgery?
(Required.)
Yes
No
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3.
Have you been exposed to anyone with COVID-19 in the last 14 days?
(Required.)
Yes
No
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4.
Have you traveled internationally or been on a cruise in the last 14 days?
(Required.)
Yes
No
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5.
Have you traveled to Arizona or Florida in the last 14 days?
(Required.)
Yes
No
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