Medical History

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Patient details:

Do you have a fever, cough, SOB, sore throat or runny nose?

No
Yes


Do you have cold/flu symptoms? Or been in contact with anyone who has cold/flu symptoms?

No
Yes


Have you been overseas in the last 14 days, or have you been in contact with anyone who has been overseas in the last 14 days?

No
Yes


I agree that I have answered these questions to the best of my ability .

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