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SORE THROAT (pananakit ng lalamunan / masakit na paglunok)
BODY PAIN (Pananakit ng katawan)
HEADACHE (Pananakit ng ulo)
FEVER FOR THE FAST FEW DAYS (lagnat sa nakalipas na mga araw)
Have you worked together or stayed in the same close environment of a confirmed COVID-19 case? (May nakasama kaba o nakatrabahong tao na kumpirmadong may COVID-19/may Impeksyon ng Coronavirus?
Have you had any contact with anyone with fever,cough,colds and sore throat in the past 2 Weeks? (Mayroon kabang nakasama na may lagnat, ubo, sipon o sakit ng lalamunan sa nakalipas na dalawang (2) Linggo?

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Have you travelled outside the Philippines in the past 14 days? (Ikaw ba ay nagbyahe sa labas ng Pilipinas sa nakalipas na 14 na araw?
Have you travelled to any area in NCR aside from your home? (Ikaw ba ay nagpunta sa ibang parte ng NCR o Metro Manila bukod sa iyong bahay?

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 If YES, Please Specify (Sabihin kung saan):

I hereby the data indicated herein for the purpose of effecting control of the COVID-19 infection. I understand that my personal information is protected by RA 10173, Data Privacy Act of 2012, and that Iam required by RA 11469, Bayanihan to Heal as One Act, to provide truthful information.

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