Page 5 - 2021
P. 5
CCVI 1
MENT
[tf· ~
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- Fever or chills
- cough
- shortness of breath or difficulty breathing
- Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell - sore throat
- congestion or runny nose
- Nausea or vomiting
- Diarrhea
· Name:_ _ _ _ _ __
Covid Result:!{~-~
Must be marked in pen)
Do Not Do This:
