MERS CoV Questions
Q1 – A Within the last month have you traveled, visited, or resided in Saudi Arabia, the United Arab Emirates (UAE), Qatar, or Jordan?
Yes <skip to Q 2>
I am currently in Saudi Arabia, the United Arab Emirates (UAE), Qatar, or Jordan? <skip to Q 2>
No <skip to Q 5>
Q2 Were or are you in (check all that apply)
Saudi Arabia <skip to appropriate country>
The UAE <skip to appropriate country>
Qatar <skip to appropriate country>
Jordan <skip to appropriate country>
<if more than one, skip to Q3>
Q2 How long were or have you been in Saudi Arabia?
Less than one month?
Between one month and one year?
More than one year?
How long were or have you been in the UAE?
Less than one month?
Between one month and one year?
More than one year?
How long were or have you been in Qatar?
Less than one month?
Between one month and one year?
More than one year?
How long were or have you been in Jordan?
Less than one month?
Between one month and one year?
More than one year?
Q3 What is the total amount of time spent in any combination of the countries?
Less than one month?
Between one month and one year?
More than one year?
Q4 How long has it been since you returned?
Less than two weeks?
Between two weeks and one month?
Have not yet returned
Q5 In the last month, to your knowledge, have you come into contact with someone who recently traveled, visited, or resided in Saudi Arabia, the UAE, Qatar, or Jordan?
Yes
No
Q6 Within the last month have you or members of your family had a severe respiratory illness?
Yes <skip to Q7>
No
Q7 – Did you or your family members seek medical treatment?
Yes
No
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Michael Stern |
| File Modified | 0000-00-00 |
| File Created | 2021-02-01 |