Have you traveled internationally within the last 14 days? *
Have you traveled outside the state of Maryland in the last 14 days? *
Do you currently have any signs or symptoms of a respiratory infection, such as a fever, cough, diarrhea, stuffy or runny nose, or sore throat? *
If "yes", were you given a diagnosis by your doctor?
In the last 14 days, have you had contact with someone with or under investigation for COVID-19, which is often referred to as the Corona Virus? *
In the last 14 days, had you had contact with someone who is ill with a respiratory illness? *