All Screenings If you’re unsure if you submitted all your screening or if you’d like to submit a prior screening you may do so here. March 21 – April 15[] 1 Step 1 I performed screenings daily / Realicé exámenes de salud diarios Full NameNombre completoaccount_circle Phone Numbernúmero de teléfonophone Daily ScreeningsEvaluación diaria3/21 - 4/15 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 Submit / Entregar keyboard_arrow_leftPrevious Nextkeyboard_arrow_right FormCraft - WordPress form builder April 16 – April 30[] 1 Step 1 I performed screenings daily / Realicé exámenes de salud diarios Full NameNombre completoaccount_circle Phone NumberNúmero de teléfonophone Daily ScreeningsEvaluación diaria4/16 - 4/30 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 100.0Exposure to individuals either confirmed or suspected cases of Covid-19 Submit / Entregar keyboard_arrow_leftPrevious Nextkeyboard_arrow_right FormCraft - WordPress form builder May 1 – May 15[] 1 Step 1 I performed screenings daily / Realicé exámenes de salud diarios Full NameNombre completoaccount_circle Phone NumberNúmero de teléfonophone Daily ScreeningsEvaluación diaria5/1 - 5/15 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 100.0Exposure to individuals either confirmed or suspected cases of Covid-19 Submit / Entregar keyboard_arrow_leftPrevious Nextkeyboard_arrow_right FormCraft - WordPress form builder May 16 – May 30[] 1 Step 1 I performed screenings daily / Realicé exámenes de salud diarios Full NameNombre completoaccount_circle Phone NumberNúmero de teléfonophone Daily ScreeningsEvaluación diaria5/16 - 5/31 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 100.0Exposure to individuals either confirmed or suspected cases of Covid-19 Submit / Entregar keyboard_arrow_leftPrevious Nextkeyboard_arrow_right FormCraft - WordPress form builder June 1 – June 15[] 1 Step 1 I performed screenings daily / Realicé exámenes de salud diarios Full NameNombre completoaccount_circle Phone NumberNúmero de teléfonophone Daily ScreeningsEvaluación diaria6/1 - 6/15 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 Submit / Entregar keyboard_arrow_leftPrevious Nextkeyboard_arrow_right FormCraft - WordPress form builder June 16 – June 30[] 1 Step 1 I performed screenings daily / Realicé exámenes de salud diarios Full NameNombre completoaccount_circle Phone NumberNúmero de teléfonophone Daily ScreeningsEvaluación diaria6/16 - 6/30 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 Submit / Entregar keyboard_arrow_leftPrevious Nextkeyboard_arrow_right FormCraft - WordPress form builder
