Welcome to Mediwell Dainfern
Your Health is our Priority
COVID19 screening form.
Zone: Doctors/Dentist/Lab/X-Ray/Baby Clinic etc
Do you have any of the following symptoms?:
New and persistent cough
Shortness of breath or any difficulty breathing
Have you been in contact with anyone in the last 14 days who is experiencing these symptoms?
Have you been in contact with anyone who has since tested positive for Covid-19?
Have you travelled abroad in the last 1-2 months? Where did you go?
Should be Empty:
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