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Texas State University CDC Health Check
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* Indicates required question
Child's Name
*
Your answer
Who is filling out this form?
*
Parent
CDC Staff
Place a check by any symptoms your child is experiencing
*
No Symptoms
Cough
Shortness of Breath
Chills
Loss of Taste or Smell
Sore Throat
Muscle Aches
Diarrhea
Rash
Atypical Behavior
Required
Is there anything the teacher needs to be aware of?
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Your answer
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