PATIENT SCREENING CHECKLIST FOR COVID-19 INFECTION Patient Screening Checklist for Covid-19 InfectionDo you have any of the following ?FeverYesNoChillsYesNoCough or coldsYesNoNasal CongestionYesNoSore ThroatYesNoShortness of breath or difficulty breathingYesNoHeadacheYesNoEasy FatigabilityYesNoMuscle PainYesNoNew loss of taste or smellYesNoAbdominal PainYesNoDiarrhea and VomitingYesNoNew onset of skin lesion, discoloration of fingers or toesYesNoDid you travel internationally or domestically for the past two (2) weeks?YesNoIf yes, where?If yes, whenDoes anyone in your household have any of the above mentioned signs and symptoms?YesNoHave you been in contact with someone who has confirmed or suspected to have COVID-19 infection in the past two weeks?YesNoSUBMIT