COVID‐19 FORM
Please answer the following questions with YES or NO:

Favor contestar las siguientes preguntas con YES o NO:
 
 
Do you have a fever or above normal temperature? / Tiene fiebre o temperatura arriba de lo normal?
 
 
Have you experienced shortness of breath or had trouble breathing? / Tiene dificultad respiratoria?
 
 
Do you have a dry cough? / Tiene tos seca?
 
 
Do you have a runny nose? / Tiene nariz mocosa?
 
 
Have you recently lost or had a reduction in your sense of smell? / Ha tenido reduccion en el sentido del olfato?
 
 
Do you have a sore throat? / Tiene dolor de garganta?
 
 
Have you been in contact with someone who has tested positive for
COVID‐19? /  Ha estado en contacto con alguien que tuvo resultado COVID-19 positivo?
 
 
Have you tested positive for COVID‐19? / Ha sido diagnosticado con COVID19 positivo?
 
 
Have you been tested for COVID‐19 and are awaiting results? / Ha hecho examen de COVID19 y esta esperando resultados?
 
 
Have you traveled  by air or cruise ship in the past 14 days? / Ha viajado por avion o crucero en los ultimos 14 dias?
I fully understand and acknowledge the above information, risks and cautions regarding a compromised immune system.

He comprendido y reconozco la informacion aqui descrita, asi como los riesgos y cuidados de un sistema inmune comprometido.