Screening Checklist for detection and management of ...
Name Staff Resident Onset Date Wing Room/Job Age/Sex Max. Temp. Rales/Wheeze/Rhonchi Cough (Dry/Productive) Nasal Congestion SOB/Resp. Distress Sore Throat Myalgia Fatigue Nausea/Vomit/Diarrhea CXR (Results) Flu Vaccine Given? ................
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