Create an Account - Increase your productivity, customize your experience, and engage in information you care about.
(SEE NUMBER ON YELLOW SUMMONS)
Examples are chronic kidney disease, chronic obstructive pulmonary disease (COPD),
immunocompromised (weakened immune system) from solid organ transplant, severe obesity
(body mass index [BMI] of 30 or higher), serious heart condition (such as heart failure, coronary
artery disease, or cardiomyopathies), sickle cell disease, or type 2 diabetes mellitus. [Note:
COVID-19 is a new disease and this list is subject to change. Changes will be posted to
[Note: Healthcare workers include physicians, nurses, nursing assistants, emergency medical
personnel, dental professionals and students, medical and nursing students, laboratory
technicians, phlebotomists, pharmacists, therapists, hospital volunteers, and some
administrative staff and environmental services staff.]
(If a thermometer is available, please take your temperature before answering this question.)
(Close contact means less than 6 feet apart for 15 minutes or more.)
This field is not part of the form submission.
* indicates a required field