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Intertwined

COVID-19 HEALTH DECLARATION

Fever or chills
Cough, Shortness of breath or difficulty breathing
Fatigue, Muscle or body aches
New loss of taste or smell
Sore throat or Congestion or runny nose
Nausea or vomiting or Diarrhea
Have you tested positive for COVID-19 in the past 10 days?
Are you currently awaiting results from a COVID-19 test?

You MUST inform your supervisor if you:
Receive a confirmed positive COVID-19 test result;
Have been diagnosed with COVID-19 by a licensed healthcare provider;
Have been told you are suspected to have COVID-19 by a licensed healthcare provider;
Experience new loss of taste and/or smell with no other explanation; or
Experience both fever (≥100.4° F) and new unexplained cough associated with shortness of breath

Tel: 718-332-6100

1723 E 12th St., 4th Floor
Brooklyn, NY 11229
USA

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© 2013 by Allied Health Group. 

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