Do you have any of these life-threatening symptoms?

Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone
Severe and constant pain or pressure in the chest
Extreme difficulty breathing (such as gasping for air, being unable to walk or talk without catching your breath, severe wheezing, nostrils flaring, grunting, or using extra muscles around the chest to help breathe)
Disorientation (acting confused or very irritable)
Unconscious or very difficult to wake up
New or worsening seizures
Signs of low blood pressure (too weak to stand, dizziness, light headed, feeling cold, pale, clammy skin)
Dehydration (dry lips and mouth, not urinating much, sunken eyes)- Refusing to drink liquids - Frequent vomiting

Are you feeling sick?

In the last two weeks, have you been in close contact with someone who has COVID-19? —excluding people who have had COVID-19 within the past 3 months.
You have been in close contact if you have
a. been within 6 feet of someone who has COVID-19 for a combined total of 15 minutes or more over a 24 hour period or
b. provided care at home to someone who is sick with COVID-19 or
c. had direct physical contact (hugged or kissed) with someone who has COVID-19 or
d. shared eating or drinking utensils with someone who has COVID-19 or
e. been sneezed on or coughed on by someone who has COVID-19

Have you traveled outside of the United States or to any location that may require you to quarantine?