TechTank COVID-19 Screener COVID19 Please enter a patient ID code as instructed by your local site administrator and the patient's home ZIP code. Remember to give the patient ID code to the patient and have them bring it back if they return for another screening * ZIP Code * NPI Number (optional) Do you have new onset cough? * Yes No Do you have new onset fever? * Yes No Are you short of breath? * Yes No Have you noticed a loss of your sense of smell or taste? * Yes No What is your age? * What is your gender? * Male Female Do you have a chronic medical condition? (i.e. Diabetes, Heart Disease, Immune Compromised) * Yes No Are you pregnant? * Yes No To the best of your knowledge, in the last month, have you had close contact with a person known to have COVID-19? * Yes No Have you been tested for COVID-19? * Yes, and negative Yes, and positive No, not tested Submit