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Employee Daily Screening
Complete this form daily
*
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Name
*
First
Last
Email
*
What is your current temperature?
*
Have you had a fever in the last 24 hours?
*
Yes
No
Have you felt sick in the last 24 hours?
*
Yes
No
Do you have any of the following symptoms? cough, fever, tiredness, difficulty breathing (severe cases) ?
*
Yes
No
Outside of work, were you with anyone beside your immediate family members
*
Yes
No
Outside of work, were you with any group of more than 5 people?
*
Yes
No
Any family member who's with you has any symptom?
*
Yes
No
If you or someone who's with you experience any symptom, you agree to report to MAPRx
*
Yes
No
Submit
Home
Clinical Trial
About Us
Our Solutions
>
Compounding
Hospice & Palliative
Home Infusion
>
Antibiotics
Quality Assurance
Contact
Get Started
For Providers
For Patients
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