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Marzo 21 – Abril 15

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1 Step 1
I performed screenings daily / Realicé exámenes de salud diarios
Full NameNombre completo
Phone Numbernúmero de teléfono
phone
Daily ScreeningsEvaluación diaria

I certify that I am screening myself, the client I care for, and their household members for: 

  • Travel to foreign locations where covid activity is rampant 
  • New identified covid-related symptoms as updated by the CDC and Texas DSHS 
  • Fever of 100.0 F° or higher 
  • Exposure to individuals either confirmed or suspected cases of Covid-19
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FormCraft - WordPress form builder

Abril 16 – Abril 30

[]
1 Step 1
I performed screenings daily / Realicé exámenes de salud diarios
Full NameNombre completo
Phone NumberNúmero de teléfono
phone
Daily ScreeningsEvaluación diaria

I certify that I am screening myself, the client I care for, and their household members for: 

  • Travel to foreign locations where covid activity is rampant 
  • New identified covid-related symptoms as updated by the CDC and Texas DSHS 
  • Fever of 100.0
  • Exposure to individuals either confirmed or suspected cases of Covid-19

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FormCraft - WordPress form builder

Mayo 1 – Mayo 15

[]
1 Step 1
I performed screenings daily / Realicé exámenes de salud diarios
Full NameNombre completo
Phone NumberNúmero de teléfono
phone
Daily ScreeningsEvaluación diaria

I certify that I am screening myself, the client I care for, and their household members for: 

  • Travel to foreign locations where covid activity is rampant 
  • New identified covid-related symptoms as updated by the CDC and Texas DSHS 
  • Fever of 100.0
  • Exposure to individuals either confirmed or suspected cases of Covid-19
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FormCraft - WordPress form builder

Mayo 16 – Mayo 30

[]
1 Step 1
I performed screenings daily / Realicé exámenes de salud diarios
Full NameNombre completo
Phone NumberNúmero de teléfono
phone
Daily ScreeningsEvaluación diaria

I certify that I am screening myself, the client I care for, and their household members for: 

  • Travel to foreign locations where covid activity is rampant 
  • New identified covid-related symptoms as updated by the CDC and Texas DSHS 
  • Fever of 100.0
  • Exposure to individuals either confirmed or suspected cases of Covid-19
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FormCraft - WordPress form builder

Junio 1 – Junio 15

[]
1 Step 1
I performed screenings daily / Realicé exámenes de salud diarios
Full NameNombre completo
Phone NumberNúmero de teléfono
phone
Daily ScreeningsEvaluación diaria

I certify that I am screening myself, the client I care for, and their household members for: 

  • Travel to foreign locations where covid activity is rampant 
  • New identified covid-related symptoms as updated by the CDC and Texas DSHS 
  • Fever of 100.0 F° or higher 
  • Exposure to individuals either confirmed or suspected cases of Covid-19
keyboard_arrow_leftPrevious
Nextkeyboard_arrow_right
FormCraft - WordPress form builder

Junio 16 – Junio 30

[]
1 Step 1
I performed screenings daily / Realicé exámenes de salud diarios
Full NameNombre completo
Phone NumberNúmero de teléfono
phone
Daily ScreeningsEvaluación diaria

I certify that I am screening myself, the client I care for, and their household members for: 

  • Travel to foreign locations where covid activity is rampant 
  • New identified covid-related symptoms as updated by the CDC and Texas DSHS 
  • Fever of 100.0 F° or higher 
  • Exposure to individuals either confirmed or suspected cases of Covid-19
keyboard_arrow_leftPrevious
Nextkeyboard_arrow_right
FormCraft - WordPress form builder

This post is also available in: English (Inglés)