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Covid-19 Health Declaration
How are you feeling today?
Full Name / Nombre y Apellidos
Where are you coming from? De donde vienes?
ID Number / Numero de Documento
Email
My body temperature is lower than 98.6°F/ 37.5°C / Mi temperatura corporal es inferior a 37.5°C
I am not experiencing COVID-19 symptoms: fever, cough, sore throat / No tengo sintomas de COVID-19: fiebre, tos, dolor de garganta
I haven’t been in close contact with a Covid-19 patient in the last 14 days / No he estado en contacto cercano con un caso positivo de COVID-19 en los ultimos 14 dias
Initials / Iniciales
Date / Fecha
I declare that the info I’ve provided is accurate & complete / Declaro que la informacion en este formulario es correcto y completo
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